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.