Stapler suture of the pharynx after total laryngectomy.
The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae.
Department of Head and Neck Surgery, Hospital das Clínicas, São Paulo School of Medicine, São Paulo; ; Department of Head and Neck Surgery, Hospital Ana Costa, Santos and Irmandade da Santa Casa de Misericórdia, Santos, Brazil;
R A
RA
Dedivitis
Centro Universitário Lusíada, Santos, Brazil.
F T
FT
Aires
Department of Head and Neck Surgery, Hospital Ana Costa, Santos and Irmandade da Santa Casa de Misericórdia, Santos, Brazil;
E G
EG
Pfuetzenreiter
Department of Head and Neck Surgery, Hospital Ana Costa, Santos and Irmandade da Santa Casa de Misericórdia, Santos, Brazil;
M A F
MA
Castro
Department of Head and Neck Surgery, Hospital Ana Costa, Santos and Irmandade da Santa Casa de Misericórdia, Santos, Brazil;
A V
AV
Guimarães
D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D017577:Cutaneous Fistula / Q000453:epidemiology* / Q000209:etiology*; D016154:Digestive System Fistula / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000209:etiology*; D010614:Pharynx / Q000601:surgery*; D011446:Prospective Studies; D013537:Sutures
Carcinoma; Cutaneous fistula; Laryngeal neoplasms; Laryngectomy; Squamous cell; Surgical staplers; Suture techniques