Two hundred forty-seven patients, followed up a mean of 18 months and up to 108 months, were retrospectively studied for problems related to or affecting tracheoesophageal puncture for voice restoration. Active cases, as well as those inactive and decreased, were included. There were 154 patients with primary and 93 with secondary tracheoesophageal puncture. Problems were encountered at least once in 137 cases (55%). The 20 types of problems identified occurred in frequencies ranging from 0.4% to 21%. Most difficulties developed within the first 6 months and in general were easily managed. However, problems such as recalcitrant leakage, difficulty with changing the prosthesis, and dislodgment of the prosthesis led to permanent tracheoesophageal puncture tract closure in 18 patients (7%).