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. 2023 Sep;75(3):1441-1446.
doi: 10.1007/s12070-023-03587-7. Epub 2023 Feb 25.

Pharyngocutaneous Fistula in Salvage Laryngectomy: Use of the Stapler Versus Manual Suturing Technique

Giovanni Salzano  1 , Fabio Maglitto  2 , Carlo Calvanese  2 , Michela Apolito  2 , Sarah Buono  3 , Pierluigi Franco  1 , Francesco Perri  4 , Luigi Angelo Vaira  5 , Rolando De Luca  6 , Francesco Antonio Salzano  7 , Luigi Califano  2 , Franco Ionna  1
Affiliations

Pharyngocutaneous Fistula in Salvage Laryngectomy: Use of the Stapler Versus Manual Suturing Technique

Giovanni Salzano et al. Indian J Otolaryngol Head Neck Surg. 2023 Sep.

Abstract

A pharyngocutaneous fistula (PCF) is the most common complication after salvage total laryngectomy (STL) with an incidence ranging from 5 to 73%, causing an increase in morbidity and delaying the patient's recovery. A surgical technique to prevent PCF formation is the use of the stapler to suture the pharyngeal mucosa. We have reviewed the medical files of 91 patients who had undergone STL, dividing the patients into two groups (manual suture vs. stapler), based on the type of pharyngeal suture performed during the STL. We found 12/49 (24.5%) cases of a PCF in group A (manual) and 5/42 (11.9%) cases of a PCF in group B (stapler). There is a statistically significant difference between the two groups with the patients in group B presenting better results in terms of the reduction of the surgical time, the length of the hospital stay and also in the restarting of oral feeding. The advantages of mechanical suturing with the stapler are reduced surgical times, a lower PCF formation rate, which involves an early removal of the nasogastric tube, and reduced hospitalization times. Further studies with a larger case series will be necessary to confirm the results obtained and to standardize the surgical technique.

Keywords: Laryngeal neoplasms; Pharyngocutaneous fistula; Surgical staplers; Total laryngectomy.

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Conflict of interest statement

Conflict of interestThe authors declare no conflict of interest

Figures

Fig. 1
Fig. 1
View of the mobilized larynx, suspended at the ends by two Allis clamps connected to the pharynx through the mucous membrane
Fig. 2
Fig. 2
Application of the stapler on the pharyngeal mucosa
Fig. 3
Fig. 3
View of the linear suture resulting from the use of the stapler
See this image and copyright information in PMC

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