Pharyngocutaneous fistula following total laryngectomy and post-operative vomiting.
The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined, 17 also underwent a simultaneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3-15 days). Several potential risk factors were examined including age, gender, previous radiotherapy, TNM stage, differentiation of tumour, simultaneous radical neck dissection and also the occurrence of vomiting post-operatively. In this series of patients only vomiting in the early post-operative period appeared to be related to the development of a fistula (regression summary: R2 = 0.6, t-value 5.6, P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subsequently developed a fistula. The median time of post-operative vomiting was 7.5 days (range 1-10 days) and the diagnosis of a fistula occurred at a mean of 1.2 +/- 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting and fistula development. However, if this is the case a potential means of decreasing the incidence of fistulae following laryngectomy may be available.
Department of Otolaryngology Head and Neck Surgery, University of Wales College of Medicine, Cardiff, UK.
A
A
Tomkinson
G R
GR
Shone
A
A
Dingle
D G
DG
Roblin
S
S
Quine
D005260:Female; D005402:Fistula / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology* / Q000601:surgery*; D011183:Postoperative Complications; D014839:Vomiting / Q000209:etiology*