'Defatting' tracheotomy in morbidly obese patients

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Abstract

Objectives/Hypothesis: Standard-sized tracheostomy tubes often fit morbidly obese patients poorly because of increased submental and anterior cervical girth. The surgeon has two options to overcome this problem: Modify the tracheostomy tube to fit the patient or recontour the neck to accommodate a standard tube. The purpose of the study was to assess the safety and morbidity of the latter technique, the "defatting" tracheotomy. Study Design: Retrospective cohort study of 23 patients treated between 1994 and 2001 with cervical lipectomy and tracheotomy. Methods: Medical charts were reviewed for indications, demographics, body mass index, tracheotomy-related complications, and decannulation results. Results: The average age of patients was 50 years (age range, 34-77 y). The mean preoperative body mass index was 55.9 (range, 39.2-73.5). Indications for the procedure were respiratory failure requiring chronic ventilation in 16 patients (70%) and obstructive sleep apnea in 7 (30%). Four patients died postoperatively from causes unrelated to tracheotomy. The mean follow-up time of survivors was 23 months. The overall tracheotomy-related complication rate was 43%. Four patients developed wound infections in the perioperative period, one patient developed a neck abscess, and one patient required neck exploration for control of hemorrhage. Four patients (22%) developed late complications including tracheitis (1), neck abscess (1), and stenosis of the tracheocutaneous tract (2). Eight patients (44%) ultimately had decannulation. Conclusions: Defatting tracheotomy is a sale technique that allows for the placement of a standard tracheostomy tube in morbidly obese patients. It is associated with a high rate of minor infectious complications. Even so, we think that cervical lipectomy with tracheostomy tube placement is the preferred surgical option for this patient population.

Original languageEnglish (US)
Pages (from-to)1940-1944
Number of pages5
JournalLaryngoscope
Volume112
Issue number11
Publication statusPublished - Nov 1 2002

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Keywords

  • Defatting
  • Morbid obesity
  • Tracheotomy

ASJC Scopus subject areas

  • Otorhinolaryngology

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