title: Outcomes of mechanical stapling for postlaryngectomy open pharyngotomy closure.
abstract: A total laryngectomy (TL) is performed as a primary or salvage therapy for laryngeal carcinoma. Pharyngotomy closure after TL is typically performed using manual sutures. Automatic stapling devices are routinely used in thoracoabdominal surgery, but have not been widely accepted for use in pharyngotomy closure. Previously described closed stapling techniques of pharyngeal closure do not allow direct evaluation of surgical margins and are limited to endolaryngeal disease. We describe an open technique for pharyngotomy closure using a mechanical stapling device.
  
  
  
  Retrospective review.
  
  
  
  A review was conducted of 16 total laryngectomies performed from May 2008 to August 2015 utilizing an Ethicon Endopath ETS Compact-Flex 45 stapler.
  
  
  
  Sixteen patients (15 male, one female), mean age 69 years, received open TL (14 salvage, two primary) with endostapler pharyngeal closure and primary tracheoesophageal puncture (TEP). Surgical time averaged 218 minutes. Median time to swallowing was 4 days (range, 2-240 days) and mean hospital stay 6 days (range, 3-10 days). Fistula incidence was 31% (5/16) overall and 36% (5/14) in the postradiation patients.
  
  
  
  Mechanical stapling is a simple method for postlaryngectomy open pharyngotomy closure. This technique allows evaluation of margins, easy primary TEP, and the opportunity for early swallowing and shorter hospital stays. In addition, it can be performed for closure of salvage laryngectomies with rates of fistula formation similar to that found in the literature using suture closure techniques. Future studies are necessary to compare oncological results and surgical complications between the open and closed stapling techniques and to traditional suture closure.
  
  
  
  4 Laryngoscope, 127:605-610, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Monash Health Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Paddle
authors.affiliation: Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Inna
authors.initials: I
authors.lastname: Husain
authors.affiliation: Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
authors.forename: Lauren
authors.initials: L
authors.lastname: McHugh
authors.affiliation: Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
authors.forename: Ramon
authors.initials: R
authors.lastname: Franco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D016019:Survival Analysis; D013718:Tensile Strength; D016896:Treatment Outcome; D058106:Wound Closure Techniques
keywords: Laryngectomy technique; laryngectomy outcomes; mechanical staple closure