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. 2021 Jun 22:11:690703.
doi: 10.3389/fonc.2021.690703. eCollection 2021.

"Fistula Zero" Project After Total Laryngectomy: The Candiolo Cancer Institute Experience

Erika Crosetti  1 , Giulia Arrigoni  1 , Andrea Elio Sprio  2 , Giovanni Succo  1   3
Affiliations

"Fistula Zero" Project After Total Laryngectomy: The Candiolo Cancer Institute Experience

Erika Crosetti et al. Front Oncol. .

Abstract

Objectives: Pharyngocutaneous fistula (PCF) is a troublesome complication after total laryngectomy. The "Fistula zero" project aims to reduce the number of PCF by following a detailed protocol based on three fundamental key points.

Materials and methods: The Fistula zero project included 77 patients who underwent total laryngectomy in the period from January 2019 to December 2020. The protocol consisted of three main aspects: the systematic placement of a Har-El salivary bypass tube, the continuous horizontal watertight pharyngeal suture using a barbed suture, onlay insetting of a pedicled flap in pre-treated patients.

Results: One case of PCF (1.3%) and three small blind fistulas (3.9%) were observed in this series. The mean length of hospitalization was 18 days.

Conclusion: Pharyngocutaneous fistula (PCF) prolongs hospitalization and delays adjuvant treatments. Thanks to a strict adherence to the protocol, it was possible to reduce PCF rates, avoiding lengthy hospitalization and additional surgical procedures.

Keywords: Montgomery tube; bypass tube; complications; head and neck cancer; laryngeal cancer; pedicled flap; pharyngocutaneous fistula; total laryngectomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Intraoperative positioning of salivary bypass tube. (B) Naso-gastric tube (NGT) insertion inside salivary tube. (C, D) Transcutaneous securing of salivary tube. (E) Salivary stent fixation on the skin.
See this image and copyright information in PMC

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