Is It Important Which Suturing Technique Used for Pharyngeal Mucosal Closure in Total Laryngectomy? Modified Continuous Connell Suture May Decrease Pharyngocutaneous Fistula

Abstract

Objective: The aim of this study is to research the correlation between pharyngeal mucosal suture techniques and pharyngocutaneous fistula (PCF) development after total laryngectomy. We also aimed to investigate other risk factor for fistula development. Methods: Medical charts of 85 patients who had total laryngectomy during August 2016 and February 2020 were reviewed. Sixteen patients were excluded due to exclusion criteria. Patients were grouped according to pharyngeal mucosal suture technique. Group 1 had modified continuous Connell suture and group 2 had interrupted submucosal suture for mucosal closure of pharynx. Demographic, medical, and surgical records reviewed for comparison. Results: Overall PCF rate was 28%;PCF rates were 16% (5/31) in group 1 and 39% (15/38) in group 2. This difference was significant (Pearson χ2 P = .033). There was no difference between groups due to age, gender, smoking history, tumor stage preoperative albumin levels, preoperative hemoglobin levels, radiotherapy status, chronic obstructive pulmonary disorder and diabetes mellitus history of patients, previous tracheostomy, neck dissection. But correlation analysis revealed that PCF formation significantly related with suture technique ( P = .032), preoperative albumin level <3.5 g/dL ( P = .028), preoperative hemoglobin level <12.5 g/dL ( P = .041), and previous radiotherapy status ( P = .012) of the patients. We also showed that suture technique is an independent predictive factor for PCF formation when other factors were controlled by univariate analysis. Conclusion: The suture technique used for pharyngeal mucosal closure, preoperative albumin level <3.5 g/dL, preoperative hemoglobin levels<12.5 g/dL, and previous radiotherapy to the head and neck are risk factors for PCF development. Modified continuous Connell suture is a good option for pharyngeal closure.

Delayed oral feeding reduces pharyngocutaneous fistula formation after open surgical treatment of primary hypopharyngeal cancer: A case-control study

“…A study based on the Japanese national inpatient database reported 20 days as the median for oral feeding after pharyngolaryngectomy for HPC patients without PCF. Some institutions do not do any test before restarting oral intake, 16,21 while others perform a methylene blue test first. 22 Based on the findings of this study, a swallow X-ray is ideal before initiation of oral intake.…”

“…Notably, there should be no tension on the first suture line. Though a modified continuous Connell suture significantly reduces PCF incidence to 16% after total laryngectomy (TL), 16 it was not preferred because it is time-consuming and inverts mucosal edges, which hinders mucosal healing. Herein, the MLFU technique in ALT reconstruction was especially useful because it significantly reduced PCF incidence for salvage cases to 3%.…”

“…Some institutions do not do any test before restarting oral intake, 16,21 while others perform a methylene blue test first. 22 Based on the findings of this study, a swallow X-ray is ideal before initiation of oral intake.…”

Impact of Different Suturing Techniques used to from Neopharynx on Postop Pharyngocutaneous Fistula Development after total Laryngectomy

“…It was found out that interrupted suturing technique is better as each individual stitch provide strength to the wall of neopharynx separately as compared to the continuous suturing technique in which a single thread is used to stitch the first layer of neopharynx through and through. As a single thread is involved in stitching in the second method it has more chances of loosening also if it gets open up at one point the entire layer can get open and hence increase chances of pharyngocutaneous fistula formation 12 .…”

Total Laryngectomy: A Review of Surgical Techniques

“…In this respect, interrupted sutures provide better security. Recent studies have shown that the use of continuous sutures is associated with lower fistula rates than interrupted sutures in mucosal repair [67,72,73].…”