Comparative Study Between Double Layered Repair of Pharyngeal Mucosa Against Routine Single Layered Repair in Cases of “Total Laryngectomy with Partial Pharyngectomy” in Respect To Formation of Pharyngo-cutaneous Fistula

Abstract

Advanced glottic cancer (T3,N? & T4) is usually treated in the majority of centres by total laryngectomy. Carcinoma of the larynx is one of the very few subsets of all cancers which have shown a decrease in the 5 year survival rate and this phenomenon has been attributed to a Pharyngocutaneous fistula is the most common complication after total laryngectomy. Comparative study between double layered repair of pharyngeal mucosa against routine single layered repair in cases of ''total laryngectomy with partial pharyngectomy''. All patients with the principal procedure of ''total laryngectomy with partial pharyngectomy'' in department of otorhinolaryngology and head-neck surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India were included in this study. Out of the 20 patients who had undergone total laryngectomy irrespective of the type of mucosal repair, 5 (25 %) patients developed pharyngocutaneous fistula. Out of the 8 patients, with double layered mucosa repair, 1 (12.5 %) patient developed pharyngocutaneous fistula. Out of the 12 patients, with single layered mucosa repair, 4 (33 %) patients developed pharyngocutaneous fistula. Double layered repair of pharyngeal mucosa is associated with a lower incidence of pharyngocutaneous fistula formation and no increased incidence of dysphagia after complete radiotherapy as compared to single layered repair.

Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review

“…Avci et al [ 43 ] compared continuous versus interrupted suture using a vertical approach and found a statistically significant difference between PCF rates favoring continuous suture (16% vs. 39%). Shukla et al [ 44 ] compared a single vs. a double-layer suture using the T-shape technique and found a statistically significant difference favoring two-layer suture (PCF rate 12.5% vs. 33.3%). Wang et al [ 45 ] and Saha et al [ 46 ] compared the two-layer suture with a modified technique using the remnant of constrictor muscles as suture reinforcement and found a statistically significant difference favoring the two-layer technique without muscle reinforcement (PCF rate 3% vs. 10% and 0% vs. 27%, respectively).…”

“…We only identified one comparative study specifically evaluating this question, showing that a continuous suture decreases the rate of PCF. Avci et al [ 43 ] found a difference of almost 20% lower rate of PCF with a two-layer suture and, although this is an observational non-RCT, the magnitude of the difference is so high that it should be accepted as conclusive [ 44 ]. Regarding the number of layers the situation was similar: two layers were more effective than a single one [ 44 ].…”

“…Avci et al [ 43 ] found a difference of almost 20% lower rate of PCF with a two-layer suture and, although this is an observational non-RCT, the magnitude of the difference is so high that it should be accepted as conclusive [ 44 ]. Regarding the number of layers the situation was similar: two layers were more effective than a single one [ 44 ]. However, when the question was if it was worthwhile adding a third layer using the constrictor muscles, the answer was not so clear.…”