Laryngotracheal separation for intractable aspiration: a retrospective review of 34 patients.

LTS is an effective surgical procedure that results in the elimination of intractable aspiration. Most of these patients have major neurologic impairment due to progressive neurologic disease or devastating injury secondary to stroke, trauma, or surgery. The procedure can be performed in ill, debilitated patients and is well tolerated, even with local anesthesia. Few patients lose communicative speech, and some patients gain the ability to swallow following the procedure. LTS should be considered in the management of patients with intractable aspiration before performance of a tracheotomy because the procedure is technically easier to perform at this time and may reduce the risk of a wound-healing complication. Postoperative nursing care is decreased, and most patients can be discharged or transferred to a chronic-care facility within 2 to 3 weeks following the procedure.