Pharyngeal Fistula After Total Larngectomy:

Ashraf Abdel Rahman Elbadawy. 

’fhisis a retrospecti ve study of 169 cases of carcinoma ofthe larynx treated surgically at the National Cancer Institute,Cairo University by total laryngectomy and followed by primaryclosure of the pharynx between 1975The purpose of thiB thesis is to review our experience withfistulae following total laryngectomy in order to isolate causativefactors and suggest preventive measuresWe f’oundthat the facters which increase the incidence of pharyngo_cutaneous fistula are :-1- Preoperative tracheostomy :_IIigher incidence of f’i.atLua was noted in thepreoperative tracheostomy group (43.25~) than thosewith no preoperative tr-dcheostomy (28.85G).2- Preoperative haemoglobin level:-Preoperative haemoglobin level below 12.5 em~rises the incidence from 29” to 64.3i; •3- Preoperative irradiation :_It increases the incidence of fistula from 29.5~in those who recieved no preoperative radiotherapy to61.5% in those who recieved preoperative radiotherapy+- Dose of radiotherapy :_The incidence of fistula was 33.3~~ in those who recieved4000 rads and 70% in those who recieved 6000 rads •5- Type of incision :_Using U-shaped incision we had the loweSt incidence offistula (26.3%) While fistula occurred in 51.2% using othertypes of incisions.6- Radical neck dissection :_thePerforming radical neck dissection in/same sitting withtotal laryngectomy increases the incidence of fistula to 48.4%while total laryngectomy alone had an incidence of fistUla of7- Post-operative drainage :_Suction drainage proved to reduce the incidence of fistulato 16.7% while using rubber drain and pressure dressing hadincidence of 39.1~~ •8- Postoperative feeding :_Nasogastric feeding tube accompanied by suction drainagegave the lowest incidence of fistUla (19.4%) •9- Site of the tumour :_There is no relation between the incidence of fistUla andthe site of the tumour.10- Suture material used for. closure of the pharynx :_No relation was found between the type of suture materialand the incidence of fistula