Stapler Assisted Total Laryngectomy: A Prospective Randomized Clinical Study

Ahmed, Omar; Abdelfattah, Hesham; Elbadan, Hisham E. M.

doi:10.1007/s12070-020-02086-3

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…Furthermore, patients undergoing stapler closure spend less time in the hospital. We report that those undergoing stapler closure spent less time in the hospital, as is supported by other studies ( 10 , 18 ). Reduced hospital time can contribute to the cost-effectiveness of the stapler.…”

Section: Discussionsupporting

confidence: 89%

“…In our study, the SS group started oral feeding 3 days earlier than the MS group, however, this did not reach statistical significance. Ahmad et al similarly reported that the stapler group started feeding earlier, however, their finding was significant ( 18 ), and Montoya et al also reported that the stapler group started oral feeding 8 days on average earlier than the manual suturing group ( 20 ). It is important to note that oral refeeding time is dependent on postoperative complications, and as we previously mentioned, the reduced operation time results in a reduced risk of complications.…”

Section: Discussionmentioning

confidence: 99%

“…An important component to consider with the reduced operation time is the time needed to close the pharyngeal defect. Ahmad et al reported that staple closure took an average of 3 minutes, compared to manual suturing which took 44 minutes on average ( 18 ). Reducing operation time has been shown to reduce the risk of postoperative systemic complications, and every additional half-hour of surgery increases the risk of complications by 14% ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Reduced hospital time can contribute to the cost-effectiveness of the stapler. While the use of the stapler is more expensive than manual suturing, the reduced operation time, reduced hospital stay, and decreased administrative costs allow the stapler closure technique to be more cost effective ( 18 ), which is especially important in a developing country such as Jordan where resources are limited for both the patients and the healthcare system. This also saves theater time for other patients.…”

Section: Discussionmentioning

confidence: 99%

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Stapler Pharyngeal Repair Versus Conventional Suturing After Laryngectomy in Jordanian Laryngeal Cancer Patients

Al-Gargaz¹,

Mohamad²,

Eid³

et al. 2022

Med Arch

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Background: The use of staplers in surgical repair of the pharynx after laryngectomy has gained traction in recent years, with differing results. Objective: In this study, we compare the use of stapler suturing (SS) after laryngectomy in comparison with the manual suturing (MS) technique in laryngeal cancer patients regarding pharyngocutaneous fistula (PCF) formation, operative time, blood loss, margin status, and length of hospital stay. Methods: We conducted a retrospective cohort study of laryngeal cancer patients undergoing pharyngeal repair after total laryngectomy by either a stapler or manual suturing. Demographic data, stage of disease, postoperative complications, duration of hospital stay, and operative time were collected. Results: A total of 59 laryngeal cancer patients were included, of which 22 underwent SS and 37 had MS. Our cohort was predominantly males (98%), and similar mean ages were observed across both suturing groups (60.5 vs 59.9, P = 0.83). Negative margins were more frequent with SS (100% vs 86.5%, P = 0.13) yet this difference was not statistically significant, whereas preoperative tracheostomy procedure was present more in MS patients (43.2% vs 0, P = 0.003). Lymph node involvement was higher in the manual suturing cohort, yet this difference was statistically insignificant (41.2% vs 25%, P = 0.49). The muscle flap procedure was significantly higher in the MS cohort (70.3% vs 20%, P = 0.001). In both groups, comparable PCF rates were noted (13.3% vs 10.8%) and there was no association between salvage laryngectomy and PCF occurrence in the entire cohort. For surgery details, there was no statistical difference between both groups in blood loss, hospitalization length, or oral feeding start. Only surgical time was significantly lower in the stapler cohort (277 vs 372.6 minutes, P = 0.000). Conclusion: Both suturing techniques did not show any statistically significant difference in PCF rates. However, was markedly reduced with stapler use in comparison to manual suturing. Further randomized studies with larger sample size are needed to validate the role of stapler suturing for pharyngeal repair.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Stapler Pharyngeal Repair Versus Conventional Suturing After Laryngectomy in Jordanian Laryngeal Cancer Patients

Al-Gargaz¹,

Mohamad²,

Eid³

et al. 2022

Med Arch

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Stapler versus conventional pharyngeal repair after total laryngectomy: a randomized clinical trial

Mandor,

Ebada,

El-Fattah

et al. 2024

Eur Arch Otorhinolaryngol

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Objectives The aim of the current study was to evaluate the functional outcomes of stapler pharyngeal closure after total laryngectomy by the incidence of PCT and assessment of swallowing after surgery. In addition, the study aimed to evaluate the oncological outcomes in terms of patients’ survival rates. Methods This randomized clinical trial was conducted on 58 patients with advanced laryngeal carcinoma who underwent total laryngectomy. Patients were randomly assigned to two groups according to the method of pharyngeal repair after laryngectomy: manual closure group (n = 28), and stapler group (n = 30). Functional and oncological outcomes were assessed and compared. Results The incidence of pharyngocutaneous fistula was significantly less in the stapler group. Additionally, operative time was significantly shorter and swallowing function was better in the stapler group compared to the manual group. There was no statistically significant difference between groups regarding survival rates. Conclusion The stapler is a reliable method for pharyngeal closure after total laryngectomy if the limits of its indications regarding the primary tumor are considered. Stapler closure decreases the incidence of PCF and decreases the surgical time. Good swallowing outcomes are achieved without compromising the oncological outcomes.

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A Novel Technique: Stapler-Assisted Total Laryngectomy with Concurrent Tracheoesophageal Prosthesis Insertion

Bollu,

Arora,

Bhatia

et al. 2024

Indian J Otolaryngol Head Neck Surg

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Stapler Assisted Total Laryngectomy: A Prospective Randomized Clinical Study

Cited by 3 publications

References 24 publications

Stapler Pharyngeal Repair Versus Conventional Suturing After Laryngectomy in Jordanian Laryngeal Cancer Patients

Stapler Pharyngeal Repair Versus Conventional Suturing After Laryngectomy in Jordanian Laryngeal Cancer Patients

Stapler versus conventional pharyngeal repair after total laryngectomy: a randomized clinical trial

A Novel Technique: Stapler-Assisted Total Laryngectomy with Concurrent Tracheoesophageal Prosthesis Insertion

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