title: Pharyngocutaneous fistula after laryngeal surgery: the role of the barium swallow.
abstract: Pharyngocutaneous fistula is one of the major complications following laryngeal surgery. Prior to 1979, patients undergoing laryngectomy at the University of Minnesota were not fed until 9 or 10 days postoperatively if unirradiated and 12 to 14 days if irradiated. Most fistulas were apparent by 14 days postoperatively, but occasionally a patient would develop a fistula as late as a month postoperatively. Starting in 1979, in an attempt to decrease the length of hospitalization as well as prevent fistula formation, routine barium-swallow videoesophagograms were obtained 7 days postoperatively in all laryngectomy patients. If the results were considered normal, the nasogastric tube was removed and oral feedings were started. Of a total of 45 patients undergoing wide-field laryngectomy, there were three clinical fistulas and three radiologic fistulas. Following this protocol, we shortened the average postoperative hospitalization by 2 days without an increase in the rate of fistulization.
mesh_terms: D001466:Barium Sulfate; D004750:Enteral Nutrition; D004947:Esophagus / Q000000981:diagnostic imaging*; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D010608:Pharyngeal Diseases / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011859:Radiography; D012871:Skin Diseases / Q000209:etiology / Q000517:prevention & control*; D014741:Video Recording
chemical_list: D001466:Barium Sulfate