Horizontal pharyngeal closure during total laryngectomy reduces rates of pharyngocutaneous fistula

• Published in: European archives of oto-rhino-laryngology Vol. 281; no. 6; pp. 3179 - 3187
• Main Authors: Giotakis, Aris I., Potamianos, Spyridon, Zachou, Zoi, Giotakis, Evangelos I., Kyrodimos, Efthymios
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2024
• Subjects: Adult; Aged; Aged, 80 and over; Cutaneous Fistula - etiology; Cutaneous Fistula - prevention & control; Female; Fistula - etiology; Fistula - prevention & control; Head and Neck; Head and Neck Surgery; Humans; Laryngeal Neoplasms - surgery; Laryngectomy - adverse effects; Laryngectomy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Otorhinolaryngology; Pharyngeal Diseases - etiology; Pharyngeal Diseases - prevention & control; Pharynx - surgery; Postoperative Complications - prevention & control; Retrospective Studies; Fistula; Prophylactic surgical procedures; Preventive medicine; Suture techniques; Laryngectomy
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-024-08593-1

Purpose
Pharyngocutaneous fistula (PCF) is a possible complication following total laryngectomy (TL), with a mean incidence of 17%. We intended to investigate the effect of pharyngeal closure type during TL on the prevention of PCF.
Methods
We retrospectively reviewed patients that underwent TL with a horizontal pharyngeal closure over a 10-year period. The frequency of PCF clinically, dysphagia, total oral diet, postoperative dilatation of the neopharynx and voice problems were tabulated.
Results
Seventy-seven subjects underwent TL due to laryngeal tumor without pharyngeal extension. Of them, 45 underwent a salvage TL. PCF occurred in 1/77 subjects. The rest of the subjects (76/77) did not develop a PCF, neither in the early nor in the late postoperative phase. All subjects (15/77) that underwent implantation of a voice prosthesis were satisfied with their voice. No subject complained about dysphagia. Every subject achieved total oral diet.
Conclusion
The horizontal pharyngeal closure is a safe pharyngeal closure technique during TL, reduces PCF rates (< 2%), results in excellent voice rehabilitation and swallowing function, and can also be used during salvage TL instead of a major pectoral flap. This type of closure should be used only in selected patients with laryngeal disease without pharyngeal extension.