Pharyngocutaneous fistula after laryngectomy--incidence, predisposing factors and outcome

The occurrence of pharyngocutaneous fistula in a totally laryngectomised patient is a serious complication as it increases patient morbidity and mortality. This paper aims to determine the incidence of the problem in our patients, to identify factors which may contribute to fistula formation and to analyse our results in managing this complication.

The case records of 69 patients who underwent total laryngectomy between April 1990 and July 1997 were assessed.

There were 11 cases of pharyngocutaneous fistula out of 69 patients with total laryngectomy, giving an incidence of 15.9%. Our findings showed that fistula formation was significantly more common in patients who had received pre-operative radiotherapy (p = 0.001) or who had tumour involved surgical resection margins (p = 0.018). The development of fistula delayed hospital discharge, and in 1 patient, contributed to sepsis and death. Of the 11 patients with fistula, 4 required surgical intervention for closure. There was a trend towards surgical repair when the size of the fistula was large (> 2 cm).

This paper identifies the patients at high risks for developing pharyngocutaneous fistula and also discusses our experience with managing this complication.