Post-Laryngectomy stricture and pharyngocutaneous fistula: Review of techniques in primary pharyngeal reconstruction in laryngectomy

B. Walton, J. Vellucci, P. B. Patel, Kristofer Jennings, S. Mccammon, Michael Underbrink

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Objective: The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy. Study Design: Retrospective Chart Review. Methods: We retrospectively reviewed a total of 151 patients over a 20-year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data. Results: The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, P=.033, vertical, P=.037), while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63). Conclusion: Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.

Original languageEnglish (US)
JournalClinical Otolaryngology
DOIs
StateAccepted/In press - 2017

Keywords

  • Fistula
  • Pharyngeal closure
  • Post-laryngectomy stricture
  • T-type closure
  • Vertical closure

ASJC Scopus subject areas

  • Otorhinolaryngology

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