Pharyngocutaneous fistulae following total laryngectomy comparison between manual and mechanical sutures

• Published in: European archives of oto-rhino-laryngology Vol. 266; no. 11; pp. 1793 - 1798
• Main Authors: Gonçalves, Antonio José, de Souza, J. A. L., Menezes, M. B., Kavabata, N. K., Suehara, A. B., Lehn, C. N.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-11-2009; Springer
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cohort Studies; Cutaneous Fistula - epidemiology; Cutaneous Fistula - pathology; Female; Head and Neck; Head and Neck Surgery; Humans; Incidence; Laryngeal Neoplasms - complications; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - surgery; Laryngectomy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Otorhinolaryngology; Otorhinolaryngology. Stomatology; Pharyngeal Diseases - epidemiology; Pharyngeal Diseases - pathology; Risk Factors; Sutures; Treatment Outcome; Fistulae; Mechanical suture; Stapler; Laryngectomy; Manual suture; Cutaneopharyngeal; Treatment; Surgery; Manuals; ENT; Comparative study; Suture
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-009-0945-4

The extension of the surgery and closure type of the pharynx can be the determinants in the pharyngocutaneous fistula development. The objective of the study is to evaluate the incidence of pharingocutaneous salivary fistulae after total laryngectomies comparing manual and mechanical sutures. The study is designed as non-randomized, prospective clinical study. Sixty patients with squamous cell carcinoma were submitted to total laryngectomies. In 30 cases, the linear stapler (75 mm) closure (surgical technique described in details) and in other 30 cases manual suture was used. The cases of mechanical suture were prospective and consecutive and the cases of manual suture were a review series of patients who underwent a manual suture of pharynx, in the same period of time. The statistical analysis between the two groups concluded that both were comparable. Fistulae incidence was 6.7% (2/30) in the group with the mechanical suture and 36.7% (11/30) in the group with manual suture closure, presenting a significant difference (
p
 = 0.0047). The total laryngectomy with mechanical closure is an easy and fast learning technique, allowing watertight closure of the pharynx with a low risk of contamination of the surgical field. It is an assured method, even in previously irradiated patients, since we respect the limits of its indication regarding the extension of primary tumor that must be confirmed by previous suspension laryngectomy performed in the operating room.