Stapler Esophageal Closure During Total Laryngectomy

Abstract

Mechanical esophageal closure with stapler during total laryngectomy has been used by various authors to decrease the surgical time and pharyngocutaneous fistula (PCF) rates. In a few of the studies, surgical site infection (SSI) rates are mentioned and none of the studies emphasize the effect of decreased surgical time on postoperative cardiovascular and cerebrovascular complications. In this study, the authors compared the PCF rates, SSI rates, operation times between 30 mechanical stapler and 40 manual esophageal closure during total laryngectomy for laryngeal cancer patients. National Nasocomial Infections Surveillance system (NNISS) scores were recorded and compared between groups. Total laryngectomy and total operation times were lower in the stapler group patients (P < 0.001 for total laryngectomy time, P = 0.024 for total operation time). There were lower rates of pharyngocutaneous fistula (P = 0.032), surgical site infection (P = 0.019), and NNISS scores (P = 0.009) in the stapler group. There was no statistically significant difference between groups regarding postoperative systemic complications (P = 0.451). In conclusion, stapler esophageal closure decreases operation time, PCF, SSI rates, and NNISS scores but not the systemic complication rates. Comorbid illnesses and prolonged surgical time are risk factors for postoperative systemic complications in total laryngectomy patients, but patients with additional illnesses must not encourage the surgeon to use stapler for decreasing postoperative systemic complications.

Pharyngeal closure after a total laryngectomy: mechanical versus manual technique

“…In most studies, mechanical sutures were associated with a significantly lower fistula rate than manual sutures. 8,12,13,17 For other studies, the results were comparable, 14 or the fistula rate was higher in patients treated with mechanical sutures although there was no significant difference. 15 According to the results of a meta-analysis carried out by Aires et al, the overall incidence of fistula in patients who underwent the mechanical suturing technique was 8.7 per cent, compared to 22.9 per cent in patients with manual sutures.…”

“…All the research indicates that the use of mechanical sutures achieves a reduction in surgical time. 7,8,13,17 Regarding the results of the meta-analysis by Aires et al ., 19 the average difference in surgical time was 80 minutes (95 per cent confidence interval = 23–136 minutes, p < 0.006). Considering the retrospective nature of our study, we cannot provide information about the surgical time reduction.…”

“…Table 3 shows the percentages of pharyngocutaneous fistulas reported by several authors using mechanical pharyngeal suturing with an open or a closed technique. The incidence of fistula ranges from 3.3 per cent 17 to 42.8 per cent. 15…”

“…Since then, several authors have published their results of using stapling devices in total laryngectomies. [6][7][8][9][10][11][12][13][14][15][16][17][18] Two techniques for mechanically suturing the pharynx have been described. In the open technique, the device is used to suture the pharyngeal mucosa after a conventional open laryngectomy.…”

Total Laryngectomy with Horizontal Mechanical Closure of the Pharyngoesophagectomy: Evaluation of the Effectiveness in Elderly Patients

“…17 The closure of pharyngoesophagectomy with stapler takes ∼ 5 minutes, while manual closing takes much longer, and its duration is relative to the experience of the surgeon. According to some authors, 15 19 the stapler reduces the duration of the surgery in ∼ between 45 and 80 minutes. All of the previous studies, excluding the one by Dedivitis et al, 7 despite their lack of homogeneity, reported a benefit in reducing the appearance of PCF in patients who underwent TL with the closure of the pharyngoesophagectomy with a stapler.…”