Efficacy of stapler pharyngeal closure after total laryngectomy: A systematic review

Abstract

Background: Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure.

Methods: The literature survey included research in MEDLINE, EMBASE, and LILACS. The intervention analyzed was stapler-assisted pharyngeal closure, whereas the control group was manual suture pharyngeal closure.

Results: The survey resulted in 319 studies. However, 4 studies were selected (417 patients). In the group of patients in whom the stapler was used, the incidence of pharyngocutaneous fistula was 8.7%, whereas in the other, it was 22.9%, with an absolute risk reduction of 15% (95% confidence interval [CI], 0.02-0.28; p = .02; I(2) = 66%). Regarding the surgical time, the average difference was 80 minutes in favor of the stapler group (95% CI, 23.16-136.58 minutes; p < .006).

Conclusion: The difference for starting oral feeding was 8 days in favor of the mechanical suture (95% CI, 4.01-11.73 days; p < .001). Patients who underwent mechanical suture had a shorter hospitalization period.

Keywords: cutaneous fistula; laryngectomy; meta-analysis; surgical staplers; suture techniques.