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Pharyngeal reconstruction after laryngectomy

E L Applebaum, H L Levine

The Laryngoscope

|November 1, 1977

Summary

This study presents a three-layer pharyngeal closure technique following laryngectomy, preventing pharyngocutaneous fistulas in 44 patients, even those with prior radiation therapy for recurrent cancer.

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Area of Science:

Otolaryngology
Surgical Oncology
Head and Neck Surgery

Background:

Pharyngocutaneous fistula is a common complication after laryngectomy, particularly in patients who have received prior radiation therapy.
Previous studies indicate a high incidence of pharyngeal fistula in irradiated patients undergoing laryngectomy.
Effective pharyngeal reconstruction techniques are crucial for minimizing postoperative complications.

Purpose of the Study:

To describe a specific method for pharyngeal reconstruction after laryngectomy.
To evaluate the efficacy of this technique in preventing pharyngocutaneous fistulas, especially in irradiated patients.
To discuss the pharyngeal repair method and its implications for fistula prevention.

Main Methods:

A three-layer pharyngeal closure technique was employed in 44 consecutive laryngectomies.
Fine, absorbable sutures were used for closure, with a submucosal inverting technique for mucous membrane approximation.
Postoperative management included a two-week period of tube feeding.

Main Results:

No postoperative pharyngocutaneous fistulas occurred in any of the 44 patients.
This technique proved effective even in ten patients with recurrent carcinomas who had previously undergone full courses of radiation therapy.
The results contrast with higher fistula rates reported in similar irradiated patient cohorts.

Conclusions:

The described three-layer pharyngeal closure technique, including submucosal inverting mucous membrane closure, effectively prevents pharyngocutaneous fistulas after laryngectomy.
This method offers a solution for reducing fistula incidence in irradiated patients, a group historically at high risk.
Careful surgical technique and appropriate postoperative care are vital for successful outcomes in laryngectomy patients.

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