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25-year experience of using a linear stapler in laryngectomy
Lev Bedrin1, Genadi Ginsburg, Zeev Horowitz
1Department of Otorhinolaryngology-Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer and the Sackler School of Medicine, Tel Aviv University, Israel. 2406@isdn.net.il
Head & Neck
|November 3, 2005
Summary
Linear stapler closure after total laryngectomy offers rapid, watertight pharyngeal closure. This technique reduces contamination and may lower fistula rates, proving effective and cost-efficient for head and neck cancer patients.
Area of Science:
- Otolaryngology
- Surgical Oncology
Background:
- Total laryngectomy necessitates pharyngeal closure.
- Stapler application offers rapid, watertight closure, minimizing contamination.
- Potential for reduced pharyngeal fistula rates is a key advantage.
Purpose of the Study:
- To evaluate the efficacy and outcomes of linear stapler application for pharyngeal closure post-total laryngectomy.
- To assess the incidence of pharyngeal fistulae and other complications.
- To determine the cost-effectiveness of the stapler technique.
Main Methods:
- Retrospective analysis of 1415 patients undergoing laryngectomy with linear stapler closure.
- Majority (98.6%) of laryngectomies were performed after radiation failure.
- Inclusion of a novel technique for simultaneous tracheoesophageal fistula and myotomy creation.
Main Results:
- An initial pharyngeal fistula rate of 12% was observed, decreasing to 5.5% in the recent decade.
- Swallowing difficulties occurred in 11 patients (0.77%).
- Local recurrences were noted in nine patients (0.6%).
Conclusions:
- Mechanical sutures via stapling provide simple, rapid application with watertight closure and good hemostasis.
- The technique prevents field contamination, supports good speech and swallowing, and is associated with low fistula and recurrence rates.
- Significant reduction in operating room expenses suggests cost-effectiveness.