Is Preoperative Tracheostomy a Risk Factor for the Post Laryngectomy Pharyngocutaneous Fistula?
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- Category: Vol. 85, June 2017
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Is Preoperative Tracheostomy a Risk Factor for the Post Laryngectomy Pharyngocutaneous Fistula?, MOHAMED ANWAR, HAZEM DEWIDAR, AHMED NASSAR and AHMED YOUSEF
Abstract
Background: Pharyngocutaneous fistula (PCF) is a com-mon complication of total laryngectomy. PCF results in prolonged hospitalization with increased medical costs, Delay of adjuvant postoperative therapy, nutritional deficits, and potentially life-threatening complications such as carotid rupture. Various risk factors have been implicated, including co-morbid illness, preoperative radiation therapy, previous tracheotomy, hemoglobin level, patient age, tumor site and stage, type of operation, concurrent neck dissection.
Methods: This study was conducted on 100 patients admitted at the otolaryngology-head and neck surgery depart-ment, Kasr Al-Aini Hospital, Cairo University suffering from laryngeal cancers and candidate for total laryngectomy in the period from February 2014 till October 2015. All patients were subjected to a preoperative assessment protocol that included history taking, examinations and investigations. On the 9th or 10th day postoperatively, oral feeding is attempted with milk to see if there is leakage from the neck or wound site, if there is none, fluids are continued in graded fashion with the nasogastric (NG) tube in place; and if after 24 hours there is still no leakage, the NG tube is removed. If there is any pharyngocutaneous fistula, oral feeding is suspended and NG tube feeding is continued for a while to allow closure of the fistula.
Results: In our study 34 patients (34%) had pharyngocu-taneous fistula, 32 patients (32%) had early fistula, 2 patients (2%) had late fistula and 66 patients (66%) did not develop fistula. In our study 42 patients had preoperative tracheostomy, 30 patients (71.4%) had not PCF, 12 patients (28.6%) had early fistula.
Conclusion: There is insignificant association between pharyngocutaneous fistula with preoperative tracheostomy.