Pharyngocutaneous fistula following total laryngectomy and post-operative vomiting

Abstract

The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined, 17 also underwent a simultaneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3-15 days). Several potential risk factors were examined including age, gender, previous radiotherapy, TNM stage, differentiation of tumour, simultaneous radical neck dissection and also the occurrence of vomiting post-operatively. In this series of patients only vomiting in the early post-operative period appeared to be related to the development of a fistula (regression summary: R2 = 0.6, t-value 5.6, P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subsequently developed a fistula. The median time of post-operative vomiting was 7.5 days (range 1-10 days) and the diagnosis of a fistula occurred at a mean of 1.2 +/- 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting and fistula development. However, if this is the case a potential means of decreasing the incidence of fistulae following laryngectomy may be available.

Postlaryngectomy pharyngocutaneous fistula: Incidence, predisposing factors, and therapy

“…Various predisposing factors have been proposed in the literature: previous radiotherapy, 1,3-12 type of surgery, 5,9,[13][14][15] combination with radical neck dissection, 11,12,16,17 the suture material used for pharyngeal reconstruction, 9 the presence of residual tumor, 5,18 previous conservative surgery, 4 previous neck surgery, 11 preoperative tracheotomy, 16,17 poor general conditions, 12 the site of origin of the tumor, 11 intraoperative blood transfusion, 19 low postoperative hemoglobin level, 6,7,16,17 type of neck drainage, 20 preoperative weight loss, 18 wound infection, [21][22][23][24] postoperative vomiting, 25 and hematoma formation. 21 The contrasting results regarding the relevance of most of the aforementioned factors could be explained in part by the lack of studies using multivariate analysis, 2,10,25 where each variable is adjusted for the others. The aim of the present study was to review the clinical data of 246 patients treated with total laryngectomy to evaluate the incidence, predisposing factors, and treatment of pharyngocutaneous fistulas.…”

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

“…In cases of late fistulization, second primary tumor of the pyriform sinus must be considered [2][3][4][5][6]. Though there are many other factors that may also be related to the incidence of PCF such as age, sex, smoking and alcohol consumption during the disease, liver function, hemoglobin status, previous radiotherapy, previous tracheostomy, neck dissection, comorbidities (diabetes, decompensated congestive heart failure, malnutrition, and chronic bronchitis) and postoperative vomiting.…”

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

“…Dieser Auffassung als Begründung für eine längere postoperative Sondenernährung muss schon insofern widersprochen werden, als auch ohne orale Nahrungsaufnahme durch das Schlucken von Speichel die Pharynxnaht ständig belastet ist. Nach unserer Auffassung ist diese Belastung aber durch die Magensonde eher erhöht,da sie als Fremdkörper stän-dig der Naht anliegt und bei jedem Schluckakt ein Reiz auf die Naht ausgeübt wird.Darüber hinaus berichteten uns Patienten wiederholt, dass die liegende Magensonde zu einer verstärkten Speichelproduktion, verstärktem Schluckreflex, Sodbrennen, Übelkeit und sogar Erbrechen führen würde.Da diese Faktoren nach der vorliegenden Literatur das Entstehen einer Speichelfistel zu begünstigen scheinen [11,23,26],ist nicht auszuschließen, dass durch die Magensonde sogar bei einigen Patienten die Gefahr einer Fistelbildung erhöht wird [3].…”