title: 25-year experience of using a linear stapler in laryngectomy.
abstract: BACKGROUND
  Stapler application for pharyngeal closure after total laryngectomy allows for rapid watertight closure without field contamination and for potentially reduced fistula rate.
  
  
  METHODS
  One thousand four hundred fifteen patients underwent laryngectomy with linear stapler closure. In 98.6%, laryngectomy was performed after radiation failure.
  
  
  RESULTS
  A relatively high incidence of pharyngeal fistulae (12%) was seen, although these rates were reduced to 5.5% during the recent decade. Simultaneous creation of tracheoesophageal fistula and myotomy by a novel technique was introduced. Swallowing problems were observed in 11 patients and local recurrences in nine patients (0.6%).
  
  
  CONCLUSIONS
  The advantages of mechanical sutures with the closed stapling technique are simple and rapid application, watertight closure with good hemostasis, prevention of field contamination, good speech and deglutition, no increase in fistula rate, and low local recurrence rates. Operating room expenses may also be significantly reduced, rendering this method cost-effective as well.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer and the Sackler School of Medicine, Tel Aviv University, Israel. 2406@isdn.net.il
authors.forename: Lev
authors.initials: L
authors.lastname: Bedrin
authors.forename: Genadi
authors.initials: G
authors.lastname: Ginsburg
authors.forename: Zeev
authors.initials: Z
authors.lastname: Horowitz
authors.forename: Yoav P
authors.initials: YP
authors.lastname: Talmi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology; D004867:Equipment Design; D005260:Female; D005402:Fistula / Q000209:etiology; D006801:Humans; D007825:Laryngectomy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010608:Pharyngeal Diseases / Q000209:etiology; D013065:Speech Intelligibility; D013528:Surgical Staplers / Q000009:adverse effects