Özet:
Introduction: Pharyngocutaneous fistula is one of the most common nonfatal laryngectomy
complications (7.6% to 65% of all total patients). Preoperative radiotherapy, advanced
tumor stage, poor preoperative medical status, and concomitant pharyngectomy are usually
accepted causative factors in fistula formation. Delay of oral feeding is a common practice
used by head and neck surgeons to prevent the development of pharyngocutaneous fistula.
In this article we analyze our experience with special emphasis given to the early start of
postoperative feeding.
Patients and Methods: The postoperative records of 48 patients who had undergone total
laryngectomy or total laryngopharyngectomy were reviewed. All patients were orally fed with
water and clear liquids on the first postoperative day. The patients were closely observed at
every feeding attempt, and if any sign of fistula was noted, a nasogastric tube was inserted.
Preoperative radiotherapy, stage of disease, tumor differentiation, and pharyngectomy with
total laryngectomy were statistically analyzed as potential risk factors contributing to fistula
formation. The Fisher exact test was used to analyze the data.
Results: The overall pharyngocutaneous fistula rate was 12.5% in our series. The only
statistically significant factor that increased the rate of fistula formation was resection of
pharyngeal mucosa as an extension of total laryngectomy. Other parameters failed to show
any statistical significance in development of this complication.
Conclusion: Evaluation of fistula incidence in our series indicates that initiating oral feeding
on the first postoperative day does not contribute to fistula formation. Additionally, the
relatively shortened hospital stay and elimination of the psychologic and traumatic side
effects of tube feeding are benefits of this approach that should be studied in further
prospective quality-of-life studies.
