Pharyngocutaneous fistula following laryngectomy

Abstract

Background Pharyngocutaneous fistula (PCF) following laryngectomy is a serious complication, and its incidence varies from 7.6% to 50%. Despite the relative frequency of this complication, there is still uncertainty about the predisposing factors. Methods A retrospective study was performed in 295 patients who underwent total laryngectomy. Results Of the 295 patients, 37 (12.5%) developed PCF. The contributing factors,—such as early oral feeding postoperatively, prior radiotherapy or tracheostomy, accompanying neck dissection,—and the surgical technique failed to show a statistically significant effect. There was statistically significant association between tumor size and PCF formation. Also, when the suture materials used for the closure of the pharynx were compared, catgut showed a higher rate of PCF formation than vicryl (p < .05). Conclusions The vicryl, when used as a suture material for the closure of the pharynx, seemed to decrease the fistula rate significantly, compared with catgut. Also, tumor stage was found to have a significant role in PCF formation, but no statistical significant difference could be demonstrated for other investigated parameters. We believe that after total laryngectomy, oral feeding can be started at the third postoperative day without increasing morbidity, which makes the patients feel more comfortable and confident without nasogastric tube. © 1998 John Wiley & Sons, Inc. Head Neck 20: 22–25, 1998.

Post-operative pharyngocutaneous fistula after laryngectomy

“…High-dose radiation is supposed to promote a cascade of events in which the fibroblast population becomes dysfunctional and depleted resulting in hypovascularity and aggravation of atherosclerosis through the induction of myointimal fibrosis, followed by diminished healing capacity of irradiated tissue (15,16,17). In contrast, some other reports did not link the PCF formation with previous radiotherapy (13,18,19). In the present study, the incidence of PCF for SL-RT was 36.4%, which is nearly twice as much as that of PL, although statistically significant difference was not achieved.…”

“…Concerning the treatment, some authors refrain from waiting for spontaneous closure because it takes a long time, prolonging patient's stay in the hospital and resulting in swallowing difficulty due to fibrosis and stenosis (18). We agree that it is not wise to wait any longer than a month to plan surgery to close the PCF.…”

Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking

“…Tosun et al (30) revealed an association of T-shaped suturation of the pharynx with the development of postoperative PCF. Soylu et al (32) demonstrated a higher incidence of PCF with the use of catgut in relation to polyglycolic acid, but no significant difference was shown among manual suturing types such as T, vertical, and horizontal closure. As shown in Table 1, we observed a higher incidence of PCF in patients in whom vertical closure and staples were used for reconstruction (46% and 67%, respectively).…”

“…Some authors support early intervention in PCF with the purpose of preventing prolonged hospital stay and prolonged enteral feeding (32). Although this opinion has many justifications, the early primary surgical closure of an existing PCF is not always easy and successful.…”

Inzidenz von Speichelfisteln in Abhängigkeit vom Zeitpunkt einer oralen Ernährung nach Laryngektomie

“…So wird in den USA von den meisten Chirurgen ein oraler Nahrungsaufbau nach dem 7. postoperativen Tag praktiziert (Übersicht in [4]). Einige Autoren postulieren sogar einen gänzlichen Verzicht auf eine Nährsonde und einen oralen Nahrungsaufbau ab dem 1. bis 3. postoperativen Tag [1,2,25]. Darüber hinaus zeigten uns einige Einzelfälle im eigenen Patientengut, dass eine Nähr-sonde möglicherweise sogar die Entstehung einer pharyngokutanen Fistel begünstigen kann.…”