Journal ID : CJOHNS-16-04-2024-11437
[This article belongs to Volume - 55, Issue - 04]

Title : A review and comparative analysis of types of closure of the pharynx and their relationship with the incidence of pharyngo-cutaneous fistula after total laryngectomy

Abstract :

Many patients operated on for head and neck cancer develop swallowing problems which lead to a significant impairment in their quality of life. One of the most frequent complications that can interfere with swallowing is the occurring of a pharyngo-cutaneous fistula. Pharyngo-cutaneous fistula is the most common complication related to the neopharyngeal reconstruction. The aim of this study was to examine the incidence of fistula and the association between fistula and the type of suture used to close the pharynx (Modified Continuous Mucosal Connell suture, Linear stapler closure of the pharynx, Continuous, inverting, horizontal Connel type technique, Prophylactic vascularized flaps to aid pharyngeal closure, Continuous submucosal suturing). For the development of this review were used peer-reviewed articles, dissertations, and conference papers, primary, but also secondary sources. The incidence is variable amongst studies, with a reported range of 3% to 65%. There are a few risk factors cited in the literature such as preoperative radiotherapy, concurrent radical neck dissection, the suture material used for pharyngeal reconstruction, the presence of residual tumor, previous neck surgery, preoperative tracheotomy, poor general conditions, preoperative weight loss, wound infection, postoperative vomiting and others. One of the lowest rates of pharyngo-cutaneous fistula formation seems to be with the modified continuous mucosal Connell suture, but analysis bias may have occurred because of the lack of well-controlled studies.

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