scholarly journals DELAYED ORAL FEEDING IN PATIENTS OF SALVAGE LARYNGECTOMY AND ITS EFFECT ON DEVELOPMENT OF PHARYNGOCUTANEOUS FISTULA

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S467-70
Author(s):  
Uzair Mushahid ◽  
Sayed Nusrat Raza ◽  
Farhan Akbar
Keyword(s):  
Total Laryngectomy ◽  
Controlled Trial ◽  
Oral Intake ◽  
Oral Feeding ◽  
Military Hospital ◽  
Pharyngocutaneous Fistula ◽  
Safe Practice ◽  
The Difference ◽  
Timing Of Initiation ◽  
Salvage Laryngectomy

Objective: Pharyngocutaneous fistula (PCF) is a complication of post radiotherapy total laryngectomy. Early post operative feeding is a risk factor for development of PCF. Delayed oral feeding (DOF) and inserting a nasogastric tube has been considered a safe practice among head and neck surgeons, and there is no general agreement on the timing of initiation of the oral intake. This study compared the effect of EOF and DOF on PCF formation. Study Design: Prospective case-controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Apr 2019 to Jul 2020. Methodology: Non-probability convenience sampling was done for both groups. The patients were not matched and were assigned to either EOF or DOF alternately. EOF was defined as feeding at seventh post operative day and DOF criterion was feeding on fourteenth post operative day. The primary outcome was development of PCF within the 30th post operative day. A total of 20 patients with prior radiotherapy for laryngeal cancer who presented with recurrence of carcinoma were included in the study. Same technique closure of neopharynx was done in all cases of laryngectomy. Results: Overall PCF frequency was 20% (4/20). In EOF group, 30% (3/10) of patients developed PCF whereas 10% (1/10) of patients in DOF developed PCF. However, the difference in outcome of two groups was not statistically significant. Conclusion: DOF in cases of Salvage total laryngectomy is a safe practice and it might help to reduce the frequency of pharyngocutaneous fistula.

Role of the pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage laryngectomy

2016 ◽  
Vol 130 (9) ◽  
pp. 860-864 ◽  
Author(s):  
S Sharma ◽  
D A Chaukar ◽  
S G Laskar ◽  
N Kapre ◽  
A Deshmukh ◽  
...  
Keyword(s):  
Primary Closure ◽  
Controlled Trial ◽  
Pectoralis Major ◽  
Pharyngocutaneous Fistula ◽  
Carcinoma Of The Larynx ◽  
Fistula Rate ◽  
Randomised Controlled ◽  
Closure Group ◽  
Salvage Laryngectomy

AbstractObjective:This study aimed to assess the utility of onlay pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage total laryngectomy.Methods:A retrospective analysis was performed of 172 patients who underwent salvage laryngectomy for recurrent carcinoma of the larynx or hypopharynx between 1999 and 2014. One hundred and ten patients underwent primary closure and 62 patients had pectoralis major myofascial flap onlay.Results:The overall pharyngocutaneous fistula rate was 43 per cent, and was similar in both groups (primary closure group, 43.6 per cent; onlay flap group, 41.9 per cent; p = 0.8). Fistulae in the onlay flap group healed faster: the median and mean fistula duration were 37 and 55 days, respectively, in the primary closure group and 20 and 25 days, respectively, in the onlay flap group (p = 0.008).Conclusion:Use of an onlay pectoralis major myofascial flap did not decrease the pharyngocutaneous fistula rate, although fistula duration was shortened. A well-designed randomised-controlled trial is needed to establish parameters for its routine use in clinical practice.

Pectoralis major myofascial flap in salvage laryngectomy

2014 ◽  
Vol 128 (8) ◽  
pp. 714-719 ◽  
Author(s):  
E Cömert ◽  
Ü Tunçel ◽  
M Taner Torun ◽  
C Kiliç ◽  
A Buğra Cengiz ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Pectoralis Major ◽  
Oral Feeding ◽  
Fistula Formation ◽  
Pharyngocutaneous Fistula ◽  
Similar Time ◽  
Significant Difference ◽  
Group 2 ◽  
Salvage Laryngectomy ◽  
Group 1

AbstractObjective:The main purpose of this study was to evaluate the effect of the pectoralis major myofascial flap on pharyngocutaneous fistula formation and time to oral feeding.Methods:This retrospective study reviewed 155 total laryngectomies. Patients were divided into two main groups. Group 1 included 110 patients who were treated primarily by total laryngectomy and group 2 comprised 45 patients who were treated by salvage laryngectomy with or without a pectoralis major myofascial flap.Results:The use of a pectoralis major myofascial flap did not have a significant effect on pharyngocutaneous fistula formation in the salvage group (p = 0.376). When comparing the oral feeding day of patients with pharyngocutaneous fistula, a significant difference was observed between the salvage group with pectoralis major myofascial flap reinforcement and the salvage group without pectoralis major myofascial flap reinforcement (p = 0.004).Discussion:Our study demonstrated that pectoralis major myofascial flap reinforcement did not decrease the rate of pharyngocutaneous fistula formation. Instead, it prevented the formation of large fistulas that would require surgical management, and showed a similar time to oral feeding and length of hospital stay to primary laryngectomy.

Pectoralis Myofascial Flap during Salvage Laryngectomy Prevents Pharyngocutaneous Fistula

2009 ◽  
Vol 141 (2) ◽  
pp. 190-195 ◽  
Author(s):  
Urjeet A. Patel ◽  
Sanjay P. Keni
Keyword(s):  
Total Laryngectomy ◽  
Public Hospital ◽  
Chart Review ◽  
Tertiary Care ◽  
Case Series ◽  
Pharyngocutaneous Fistula ◽  
Reliable Technique ◽  
Fistula Rate ◽  
Salvage Laryngectomy ◽  
Pectoralis Flap

OBJECTIVE: To determine the rate of pharyngocutaneous fistula after salvage laryngectomy and assess if pectoralis myofascial flap reinforcement over primary pharyngeal closure prevents pharyngocutaneous fistula. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-care public hospital. SUBJECTS AND METHODS: This study included 43 patients undergoing total laryngectomy between 2003 and 2008. Pectoralis myofascial flap reinforcement of the pharyngeal closure during salvage laryngectomy was performed on patients after June 2006. The main outcome measure was pharyngocutaneous fistula after primary laryngectomy, salvage laryngectomy, and salvage laryngectomy with pectoralis flap reinforcement. RESULTS: Of the 43 patients, 26 were treated with primary total laryngectomy while 17 received salvage laryngectomy. Seven of 26 patients (27%) undergoing primary total laryngectomy developed pharyngocutaneous fistula. All patients in this group were closed primarily with no flap reinforcement. For salvage laryngectomy, four of seven patients (57%) with primary pharyngeal closure developed pharyngocutaneous fistula; however, none of 10 patients (0%) undergoing salvage laryngectomy with pectoralis myofascial flap reinforcement developed fistula ( P < 0.02; 0%-23%; 95% CI). CONCLUSIONS: With pectoralis myofascial flap reinforcement, pharyngocutaneous fistula rate after salvage laryngectomy dropped to 0 percent in this study (0%-23%; 95% CI). This is a simple, reliable technique that prevents postoperative pharyngocutaneous fistula and its associated morbidity after salvage laryngectomy.

scholarly journals SURGICAL SITE INFECTION

2018 ◽  
Vol 25 (01) ◽  
pp. 1-4
Author(s):  
Syed Muhammad Nauman ◽  
Yousaf Haroon ◽  
Asrar Ahmad ◽  
Irum Saleem
Keyword(s):  
Antibiotic Prophylaxis ◽  
Controlled Trial ◽  
Wound Infection Rate ◽  
Low Risk ◽  
Military Hospital ◽  
Site Infection ◽  
Duration Of Symptoms ◽  
Group A ◽  
The Difference ◽  
Group B

Objectives: To compare antibiotic prophylaxis in preventing frequency ofpostoperative surgical site wound infection rate in low risk laparoscopic cholecystectomywith controls. Study design: Randomized Controlled Trial. Setting: Department of Surgery,Combined Military Hospital, Rawalpindi. Duration of study: This study was conducted from11-07-2015 to 10-01-2016. Subjects and methods: A total of 650 patients (325 in each group)were included in the study. Patients in group-A received antibiotic prophylaxis whereas patientsin group-B did not receive any antibiotic prophylaxis. Results: Mean age of the patients was44.91±13.37 and 42.28±13.76 years in group-A and B, respectively. In group-A there were152 patients (46.7%) and in group-B 148 patients (45.5%) were males. In group-A 173 patients(53.3%) and in group-B 177 patients (54.5%) were females. In group-A, superficial site infectionwas seen in 4 patients (1.2%) and in group-B superficial site infection was observed in 13patients (4.0%). The difference between two groups was statistically significant (p=0.027).Mean duration of symptoms was 5.75±0.50 and 5.77±0.92 days in group-A and B, respectively.Stratification with regard to age, gender and duration of symptoms was carried out. Conclusion:In conclusion, we recommend the use of pre-operative prophylactic antibiotics for patientswho are undergoing elective low-risk laparoscopic cholecystectomy inorder to prevent postoperativeinfectious complications.

Stapled closed technique for laryngectomy and pharyngeal repair

2008 ◽  
Vol 122 (11) ◽  
pp. 1245-1248 ◽  
Author(s):  
F Ahsan ◽  
K W Ah-See ◽  
A Hussain
Keyword(s):  
Hospital Stay ◽  
Total Laryngectomy ◽  
Oral Intake ◽  
Surgical Margins ◽  
Linear Stapler ◽  
Pharyngocutaneous Fistula ◽  
Closed Technique ◽  
Stapler Device ◽  
The Mean ◽  
Endoscopic Assessment

AbstractBackground and aims:Total laryngectomy is a recognised treatment for advanced laryngeal carcinoma. Traditionally, pharyngeal repair is performed with layered sutures. We describe our experience with a technique of closed pharyngoplasty using a linear stapler device.Material and methods:Ten total laryngectomies were performed from July 2002 to July 2004, using an Ethicon TLC 75 linear stapler for pharyngeal closure. Data collected included age, sex, staging, endoscopic assessment, surgical margins and post-operative course (including complications and swallowing).Results:Patients comprised eight men and two women. The mean age was 55.4 years. Six patients had stage T4 endolaryngeal carcinoma and four had stage T3. Four patients underwent pre-operative radiotherapy. Clear surgical margins were achieved in all patients. One patient developed a pharyngocutaneous fistula. Patients resumed oral intake at 48 hours, or at 72 hours if they had undergone pre-operative radiotherapy. Patients' mean hospital stay was seven days.Conclusion:This stapled closed technique for pharyngoplasty is efficient and eliminates the risk of wound contamination, thus theoretically reducing the risk of tumour seeding. In addition, we were able to commence patients on oral fluids at a mean of 48 hours after surgery. The mean hospital stay was seven days. We recommend this technique as an alternative for repairing the pharynx in patients undergoing total laryngectomy for endolaryngeal carcinoma.

scholarly journals A review of pharyngeal mucosal closure technique in total laryngectomy

2018 ◽  
Vol 5 (1) ◽  
pp. 145
Author(s):  
Gopu Govindasamy ◽  
Subbiah Shanmugam ◽  
Arul Murugan
Keyword(s):  
Medical Records ◽  
Total Laryngectomy ◽  
Salvage Surgery ◽  
Pharyngocutaneous Fistula ◽  
Closure Technique ◽  
Carcinoma Of The Larynx ◽  
The Impact ◽  
Salvage Laryngectomy ◽  
Radiotherapy Failure ◽  
Hospital Center

<p class="abstract"><strong>Background:</strong> The purpose of this retrospective analysis was to review our single institute based experience with the pharyngocutaneous fistula following total laryngectomy and to determine the impact of pharyngeal closure technique in the development of PCF in our patients.</p><p class="abstract"><strong>Methods:</strong> The medical records of the patients, who underwent total laryngectomy for squamous cell carcinoma of the larynx and hypopharynx in Government Royapettah Hospital, center for oncology between January 2010 and December 2017, were retrospectively reviewed.  </p><p class="abstract"><strong>Results:</strong> 26 patients were included in the study of which 25 were male and 1 was female. Mean age of the patients were 58 years. Horizontal closure was done in 9 patients (35%) and T closure was done in 17 patients (65%). PCF was observed in 1 of 9 patients in horizontal closure. Remaining 17 patients underwent T closure of whom 8 patients developed PCF (p=0.06). Eight out of 18 patients (44%) developed PCF after salvage surgery after radiotherapy failure, Remaining 8 patients underwent primary laryngectomy for advanced stage cancers with cartilage involvement, of whom 1 patient developed PCF (12.5%) (p=0.11). In salvage laryngectomy (n=18), 1 of 6 cases developed PCF in horizontal closure and 7 of 12 cases in T closure technique (p=0.09).</p><p class="abstract"><strong>Conclusions:</strong> The incidence of fistula in our study was 34%. Horizontal closure was associated with decreased incidence of PCF when compared to ‘T’ closure of the defect. Prior radiotherapy had increased incidence of PCF.</p>

Tissue transfer to post-chemoradiation salvage laryngectomy defects to prevent pharyngocutaneous fistula: single-centre experience

2014 ◽  
Vol 128 (4) ◽  
pp. 365-367 ◽  
Author(s):  
J Powell ◽  
U R Ullal ◽  
O Ahmed ◽  
M Ragbir ◽  
V Paleri
Keyword(s):  
Total Laryngectomy ◽  
Primary Closure ◽  
Pharyngocutaneous Fistula ◽  
Retrospective Assessment ◽  
Tissue Transfer ◽  
Single Centre Experience ◽  
Tissue Flap ◽  
Soft Tissue Flap ◽  
Closure Group ◽  
Salvage Laryngectomy

AbstractBackground:In recent practice, we have used tissue transfer (pedicled or free flap) to augment the pharyngeal circumference of the neopharynx following salvage total laryngectomy, even in patients who have sufficient pharyngeal mucosa for primary closure. In this study, the rates of pharyngocutaneous fistula were compared in soft tissue flap reconstructed patients versus patients who underwent primary closure.Method:A retrospective assessment was carried out of all patients who had undergone a salvage total laryngectomy between 2000 and 2010. The presence or absence of a pharyngocutaneous fistula was compared in those who received reconstruction closure versus those who received primary closure.Results:The reconstruction closure group (n = 7) had no incidence of pharyngocutaneous fistula, whereas the primary closure group (n = 38) had 10 fistulas, giving pharyngocutaneous fistula rates of 0 per cent versus 26 per cent, respectively.Conclusion:The findings revealed a lower rate of pharyngocutaneous fistula with tissue transfer compared with primary closure of the neopharynx.

scholarly journals Early versus delayed oral feeding post total laryngectomy and relation to trachea-oesophageal fistula formation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H A Elibiary ◽  
T A Aboelezz ◽  
O M Mady ◽  
A O T Keshk
Keyword(s):  
Hospital Stay ◽  
Total Laryngectomy ◽  
Malignant Tumors ◽  
Group Versus ◽  
Oral Feeding ◽  
Fistula Formation ◽  
Voice Rehabilitation ◽  
Pharyngocutaneous Fistula ◽  
Early Oral Feeding ◽  
Feeding Group

Abstract Background total laryngectomy is the most common procedure in treatment of advanced laryngeal malignant tumors. Total laryngectomy although an important and reliable method of management, still carries a lot of short term and long term complications. One of the common complications is the pharyngocutaneous fistula. Being a major risk factor of longer hospital stay, morbidity and wound infection. Pharyngocutaneous fistula is studied carefully concerning causes, risk factors and management. Oral feeding and voice rehabilitation are two valuable outcomes for the patient. Both could be disturbed by occurrence of pharyngocutaneous fistula. Oral feeding usually starts by the seventh to tenth day postoperative to allow adequate time for pharyngeal closure as believed by many surgeons for decades. Recent studies including our study discuss the possibility of early oral feeding versus conventional delayed feeding and its advantages regarding hospital stay and incidence of fistula. Aim The aim of this study is to points out the rate of pharyngocutaneous fistulae incidence after total laryngectomy in two different groups of patients depending on timing of post-operative oral feeding. Oral feeding usually starts after 7-10 days of surgery to allow for complete healing and closure of pharyngeal repair. Methodology A meta-analysis study is done to assess the feasibility and the possibility of early oral feeding after total laryngectomy versus delayed oral feeding. The outcome is the occurrence of pharyngocutaneous fistula in each group. Results In all included studies the incidence of pharyngocutaneous fistula was 168/1374 (12.23%) in early feeding group versus 69/570 (12.11%) in the delayed feeding group. The statistical difference was insignificant P &gt; 0.05 Conclusion Early oral feeding after total laryngectomy during the first 72 hours post-operative is a safe clinical practice and results in shorter hospital stay.

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