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Post-laryngectomy pharyngocutaneous fistula--a still unresolved problem
M Fradis1, L Podoshin, J Ben David
1Department of Otolaryngology-Head and Neck Surgery, Bnai Zion Medical Centre, Haifa, Israel.
The Journal of Laryngology and Otology
|March 1, 1995
Summary
Post-operative fistula formation after total laryngectomy occurred in 12.5% of patients. Managing fistulas with oral feeding and a nasogastric tube may promote spontaneous closure, avoiding surgery.
Area of Science:
- Otorhinolaryngology
- Surgical Oncology
Background:
- Total laryngectomy is a surgical procedure for advanced laryngeal cancers.
- Post-operative complications, such as fistula formation, can impact patient outcomes.
Purpose of the Study:
- To investigate the incidence and potential risk factors of post-operative fistula formation following total laryngectomy.
- To evaluate conservative management strategies for post-operative fistulas.
Main Methods:
- Retrospective analysis of 56 total laryngectomy cases operated by a single surgeon over 16 years (1976-1992).
- Review of patient records to identify fistula occurrence and associated factors, including tumor stage, infection rates, age, and prior neck irradiation.
- Observation of outcomes for patients managed conservatively for fistula.
Main Results:
- The incidence of post-operative fistula formation was 12.5%.
- No significant relationship was found between fistula formation and infection rate, patient age, or previous neck irradiation.
- A trend towards more fistulas was observed in patients with late-stage tumors.
- Conservative management (oral solid food with nasogastric tube for fluids) led to spontaneous fistula closure in some cases.
Conclusions:
- Fistula formation after total laryngectomy is a notable complication, occurring in 12.5% of cases in this series.
- Specific pre-operative factors like infection, age, and prior irradiation did not show a significant correlation with fistula development.
- Conservative management involving oral feeding and nasogastric fluid administration shows promise for spontaneous fistula closure, potentially obviating the need for secondary surgical repair.