Early Detection and Treatment of Postoperative Pharyngocutaneous Fistula

Friedman, Michael; Venkatesan, Thiagarajan; Yakovlev, Alexander E.; Lim, Jessica; Tanyeri, Hasan; Caldarelli, David D.

doi:10.1016/s0194-5998(99)70224-x

Cited by 45 publications

(39 citation statements)

References 12 publications

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“…Pharyngocutaneous fistulae after laryngectomy occur when there is a breakdown or inadequate closure of the suture line. [2,4] It presents with wound erythema, followed by skin slough and salivary flow through a cutaneous orifice. The presence of a fistula will usually become clinically apparent 7–11 days after surgery.…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of abnormal findings on radiographic swallowing studies after total laryngectomy

Parra¹

2007

Cancer Imaging

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Pharyngocutaneous fistulae are a common complication after total laryngectomy. Our study evaluates the correlation of postoperative radiographic swallowing studies and clinical symptoms. We also propose a grading system to classify leaks radiographically. The records of 45 patients who underwent total laryngectomy were retrospectively reviewed. All patients had a radiographic swallowing study (RSS) on or around the tenth postoperative day. A grading system was developed to classify radiographic findings (grade 0–5). Twenty-two patients had an abnormal RSS (grade 2–5). Three patients (13.6%) had clinical signs of impending fistula whereas radiography showed moderate leakage (grade 3) in one patient and a pharyngocutaneous fistula (grade 5) in two. The other 19 patients with radiographically demonstrated leakage had no clinical signs of anastomotic complications. After total laryngectomy, radiography may reveal anastomotic complications of varying severity. The grading system used in this study enabled us to objectively classify the radiological abnormalities on swallowing studies. Because most radiographic leakages were clinically silent and not all clinically apparent fistula were radiographically visible in our study, the role of routine postoperative radiographic swallowing studies in the absence of clinical signs or fistula remains unclear.

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Section: Introductionmentioning

confidence: 99%

The prognostic value of abnormal findings on radiographic swallowing studies after total laryngectomy

Parra¹

2007

Cancer Imaging

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“…It is a complex, dynamic and systemic process, depending on the general health conditions of the patient with larynx neoplasm, and can be delayed by several intrinsic factors (age, preexistent diseases, radiotherapy, among others), which the nurse should identify in order to promote the continuity of the treatment process (9) . (10)(11)(12)(13)(14)(15)(16)(17)(18) .…”

Section: Results Of the Categories Extracted From The Studiesmentioning

confidence: 99%

“…Its development can double the average time of patient hospitalization, and consequently increase the costs (10,15) .…”

Section: Results Of the Categories Extracted From The Studiesmentioning

confidence: 99%

“…Considering an average hospital stay of 28 days, with average time for scarring of pharyngocutaneous fistulae of 36 days (10,(15)(16)(27)(28)(31)(32) , a significant increase in nursing care directed at these patients is observed during the whole period in hospital, because it is difficult to treat this problem, demanding more financial investments for hospital service maintenance. …”

Section: Results Of the Categories Extracted From The Studiesmentioning

confidence: 99%

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Pharyngocutaneous fistulae after total laryngectomy: a systematic review

Santana¹,

Sawada

2008

Rev. Latino-Am. Enfermagem

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Santana ME, Sawada NO. Pharyngocutaneous fistulae after total laryngectomy: a systematic review. Rev Regarding the epidemiology of larynx cancer, its incidence is higher in men than in women, predominantly affecting the age range between 50and 70 years old. For 2005, it is estimated that there will be 160,000 new cases in males and 22,000 in females, with an estimated number of 89,000 deaths among men and 12,000 among women (1) .The main forms of treatment for head and neck cancer include surgery and radiotherapy.Initially, these are used aiming for cure. However, in some circumstances, they serve as a palliative treatment, and may be associated to other therapies Evidence-based practice provides decision-making based on scientific knowledge.In view of the above, this systematic review was elaborated. This research method is an EBP resource, aimed at collecting and analyzing the scientific knowledge produced about the investigated theme. Systematic reviews identify finished studies that address a research topic and evaluate the results of these studies to reach conclusions about a body of knowledge. In trying to contribute to healthcare for surgical patients, aiming at minimizing the effects of pharyngocutaneous fistulae complications, this review was developed to identify the main treatments for pharyngocutaneous fistulae after total laryngectomy. METHODSystematic reviews enable researchers to evaluate the evidence available in literature, particularly in the clinical practice area, since the knowledge acquired in this investigation will contribute to the treatment and implementation of interventions with a view to better healthcare. The systematic review is "the application of scientific strategies that limit the biases for a systematic gathering, critical evaluation and synthesis of all the relevant studies about a specific topic".Nurses have developed studies using the systematic review as their method of choice, whose goal is to gather scientific knowledge to support the interventions that respond to patients' problems in clinical practice. METHODOLOGICAL PROCEDUREThe guiding question to construct the present systematic review was "What are the main treatments available for the patient with a pharyngocutaneous fistula after total laryngectomy".In order to reach the proposed objective, a 775The data were collected independently by two reviewers. These data were checked for agreement.The discordant results were solved by consensus. The data about study population, treatment and outcomes were collected by both reviewers, using an instrument to evaluate the articles, which was built by the researchers and was subject to face and content validation.After collecting data from the studies included in the systematic review, a descriptive analysis was performed, allowing the evaluation of the data from the studies included in this systematic review about the quantitative distribution of an event in the population. RESULTS Studies included in the systematic reviewThirty-five articles were obtained through the bibl...

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Esophageal injury is most commonly identified postoperatively with the development of abscess, tracheoesophageal fistula, or mediastinitis. Intraoperative detection of injury allows for immediate treatment and improved outcomes.…”

Section: Discussionmentioning

confidence: 99%