Pharyngocutaneous fistulas after total laryngectomy or pharyngolaryngectomy: Place of video‐fluoroscopic swallowing study

Abstract

Background: Specify place of video-fluoroscopic swallowing study (VFS) in the decision of oral refeeding after total pharyngolaryngectomy. Methods: At postoperative day 7, a blue dye testing was performed. If negative, a VFS was performed looking for a blind fistula. If this exam was negative, oral refeeding was started, but if a blind fistula was observed, cervical compression bandage was performed. Results: In 186 patients, a VFS was performed for 142 patients with negative blue dye testing. It was negative for 98 patients (69%) and positive for 44 patients (31%) (blind fistula). Patients had a probability of 7.1% to have a secondary pharyngocutaneous fistula (PCF) if the VFS was negative, and 15.9% if it was positive. No risk factor for the development of a secondary PCF or a blind fistula emerged from our analysis. Conclusion: VFS should be performed before any oral refeeding in all patients operated with a total pharyngolaryngectomy.

Videofluoroscopic swallowing study to detect pharyngeal leak after total (pharyngo‐) laryngectomy: Retrospective assessment of a single‐institution protocol

“…Van La Parra et al created a grading system to classify leaks radiographically, which might help to determine which PL portends a higher risk to turn into a PCF 17 . Carsuzaa et al suggested to perform a blue‐dye test before VFSS to detect PCF; however, this did not appear useful in our series as only two patients out of 248 had a PCF at the time of initial VFSS 14 …”

“…17 Carsuzaa et al suggested to perform a blue-dye test before VFSS to detect PCF; however, this did not appear useful in our series as only two patients out of 248 had a PCF at the time of initial VFSS. 14 The overall diagnostic performance of VFSS in the detection of PL after TL seems acceptable (Table 4). However, two retrospective studies warned against the poor diagnostic performance of VFSS in the salvage setting.…”

“…While VFSS is a standard imaging to detect a leak after esophagectomy, few studies about VFSS after TL or TPL have been published to this date. 7,11,[13][14][15][16][17][18] Table 4 shows the results of the literature review, alongside the main findings of each study. All studies were retrospective.…”

Clinical outcomes following pharyngolaryngectomy reconstruction: a 20-year single-centre study

“…Overall, our data correspond to the lower end of reported rates for these complications, despite broad inclusion criteria for each. In the literature, the incidence of complications varies from 4.6 per cent to 48.8 per cent 29 for fistula, and from 11 per cent to 60 per cent for strictures. 30,31 In addition, pharyngeal resection is associated with a variety of complications and significant overall morbidity.…”