title: The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia.
abstract: OBJECTIVE
  In total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with "T"-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and "T"-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia.
  
  
  METHODS
  In our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted.
  
  
  RESULTS
  Patient demographics were similar between the vertical-shaped closure and the "T"-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with "T"-shaped closure (p < 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090).
  
  
  CONCLUSIONS
  Formation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with "T"-shaped closure of the neopharynx. It is favorable to implement "T"-shaped closure in laryngectomy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU Medical Centre, Amsterdam, The Netherlands. martinevdkamp@hotmail.com.
authors.forename: Martine F
authors.initials: MF
authors.lastname: van der Kamp
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Rico N P M
authors.initials: RNPM
authors.lastname: Rinkel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Simone E J
authors.initials: SEJ
authors.lastname: Eerenstein
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D004240:Diverticulum / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D058106:Wound Closure Techniques / Q000009:adverse effects*
keywords: Dysphagia; Head and neck surgery; Laryngectomy; Oncology; Pseudo-diverticulum; Suture methods