Laser ablation of granulation tissue at the tracheoesophageal puncture site

Background. Tracheoesophageal fistula speech may be complicated by granulat ion tissue around the puncture site. Treatment includes antibiotics, antifu ngals, chemical or electrocautery, and surgical excision of the granulation tissue. Chemical cautery generally requires repeated treatment sessions. Methods. We report our technique and results of CO, laser ablation of granu lation tissue at the tracheoesophageal puncture site performed as an outpat ient office procedure. Results. Seven of 9 patients (78%) were cured with a single treatment. The prosthesis was replaced immediately after laser ablation of granulation tis sue. Of the remaining 2 patients, 1 had a recurrence a year later, requirin g repeated laser. The second patient had a large mass requiring 4 laser abl ations. There were no complications. Conclusions. CO, laser has the following advantages compared with other met hods of treating stomal granulation tissue: office procedure; 78% cured wit h single treatment; and the extent of tissue necrosis is predictable. (C) 2 000 John Wiley & Sons, Inc.