title: Efficacy of stapler pharyngeal closure after total laryngectomy: A systematic review.
abstract: BACKGROUND
  Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure.
  
  
  METHODS
  The literature survey included research in MEDLINE, EMBASE, and LILACS. The intervention analyzed was stapler-assisted pharyngeal closure, whereas the control group was manual suture pharyngeal closure.
  
  
  RESULTS
  The survey resulted in 319 studies. However, 4 studies were selected (417 patients). In the group of patients in whom the stapler was used, the incidence of pharyngocutaneous fistula was 8.7%, whereas in the other, it was 22.9%, with an absolute risk reduction of 15% (95% confidence interval [CI], 0.02-0.28; p = .02; I(2) = 66%). Regarding the surgical time, the average difference was 80 minutes in favor of the stapler group (95% CI, 23.16-136.58 minutes; p < .006).
  
  
  CONCLUSIONS
  The difference for starting oral feeding was 8 days in favor of the mechanical suture (95% CI, 4.01-11.73 days; p < .001). Patients who underwent mechanical suture had a shorter hospitalization period.
authors.affiliation: Centro Universitário Lusíada, Santos, Brazil.
authors.forename: Felipe T
authors.initials: FT
authors.lastname: Aires
authors.forename: Rogério A
authors.initials: RA
authors.lastname: Dedivitis
authors.forename: Mario Augusto F
authors.initials: MA
authors.lastname: Castro
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo
authors.forename: Claudio Roberto
authors.initials: CR
authors.lastname: Cernea
authors.forename: Lenine Garcia
authors.initials: LG
authors.lastname: Brandão
mesh_terms: D017577:Cutaneous Fistula / Q000517:prevention & control / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D013528:Surgical Staplers; D013536:Suture Techniques / Q000295:instrumentation*; D014945:Wound Healing / Q000502:physiology
keywords: cutaneous fistula; laryngectomy; meta-analysis; surgical staplers; suture techniques