Pharyngocutaneous fistula following total laryngectomy: a single institution’s 10-year experience

Abstract

The etiology of postoperative pharyngocutaneous fistula (PCF) formation following major head and neck surgery is multifactorial and the incidence varies greatly. We reviewed retrospectively the records of 108 consecutive patients who underwent a total laryngectomy during the period from December 1992 to December 2002 at the Helsinki University Central Hospital, Helsinki, Finland. PCF occurred postoperatively in 19 (18%) patients. Two additional patients (2%) developed a PCF later than 30 days after laryngectomy. Nineteen percent of these patients with fistula formation had received previous radiation therapy and laryngectomy was performed for local recurrence. Eighteen (86%) of the all fistulae closed spontaneously and surgical closure of the fistula was performed in three (14%) cases. We conclude that the PCFs in our patient population occurred both in radiated and nonirradiated patients. Although most fistulae close spontaneously without surgical intervention this complication leads to prolonged hospitalization and increased patient morbidity.

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

“…In a recent study, Benson et al (5) reported the incidence as 34%. Our incidence of PCF (20.2%), which is still high, lies within the mid-range of previous series (1,(5)(6)(7)(8).…”

“…Although this opinion has many justifications, the early primary surgical closure of an existing PCF is not always easy and successful. According to our experience, as some PCFs spontaneously close with appropriate treatment, our initial approach was conservative treatment, as reported in other studies (7,13,14). However, if 2 weeks of conservative treatment fails, surgical intervention is required to attempt to close the fistula.…”

Treatment of large pharyngotracheal fistulas after laryngectomy by a novel customized pharyngeal stent

“…Post-surgical TPF or pharyngocutaneous fistulas occur within 30 days after surgery in majority of the cases and tend to close spontaneously [8,15]. Once radiochemotherapy has been conducted, the spontaneous closure of such fistulas becomes less common and surgical approaches have to be considered [25].…”

Fístula faringoesofágica tras paratiroidectomía por abordaje mínimamente invasivo

“…La fístula faringoesofágica está ampliamente descrita como complicación postoperatoria de la cirugía de la columna cervical a través de un abordaje anterior, en el que es necesario disecar el espacio prevertebral, muy próximo a la cara esofágica posterior 6 , y en las laringuectomías, adyacentes a la cara anterior del esófago 7 . Sin embargo, la lesión faringoesofágica es un hecho inusual en la cirugía paratiroidea, ya que la cara lateral del esófago está teóricamente lejos del campo quirúrgico de la paratiroides.…”