[Fistula following total laryngectomy. Retrospective study and bibliographical review].
BACKGROUND
The pharyngocutaneous fistulae is troublesome and the most common complication following total laryngectomy. Our objective was to determine the incidence of pharingocutaneous fistulae after the total laryngectomy in our serie and to make review of the medical literature.


METHODS
We made a retrospective study of a serie of 81 consecutive cases of laryngeal carcinoma treated between 1995 and 2008 in our section. Total laryngectomy was performed in 29 cases and 52 patients treated with organ preservation approach, were excluded. In 14 cases, the procedure was combined with radical neck dissection, pharyngeal resection or myocutanenous flaps. Nasogastric tube for feeding in the postoperative period was used in all patients and surgical gastrostomy was performed in 5 cases.


RESULTS
Our incidence of fistulas when total laryngectomy was the alone procedure is 20 % and 34.5 % when simultaneous surgical proceedings were associated. Spontaneous closure was noted in 80 % of the cases and the mean hospitalization time was 23 days.


CONCLUSIONS
Most of the fistulas can be managed with conservative treatment. Pectoralis major myocutanenous flap is appropriate when conservative treatment has failed. In small fistulas, nasogastric or gastrostomy tube for feeding can be successfully managed in the ambulatory follow up. The cost-benefit relation must be better analyzed.
Sarra
Luis D
LD
Sección de Cirugía de Cabeza y Cuello, Servicio de Otorrinolaringología, Hospital Municipal Dr. Diego E. Thompson, General San Martín, Buenos Aires, Argentina. lsarra@intramed.net.ar
Rodríguez
Juan C
JC
García Valea
Mariela
M
Bitar
Julio
J
Da Silva
Alejandro
A
D000328:Adult; D000368:Aged; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007412:Intestinal Fistula / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies