Pharyngocutaneous fistula after total laryngectomy: Less common with mechanical stapler closure.

Objective: The aim of the study was to compare the incidences of pharyngocutaneous fistula after total laryngectomy between patients who underwent manual and mechanical suturing for pharyngoesophageal closure.

Methods: In a retrospective and prospective nonrandomized clinical study conducted at a single tertiary medical center between May 2002 and April 2009, we compared the incidence of pharyngocutaneous salivary fistula between two groups of patients after total laryngectomy. Sixty-one consecutive patients who underwent mechanical suturing with a 60-mm linear stapler (group A) were prospectively enrolled, and 121 patients who had undergone manual suturing (group B) were retrospectively reviewed.

Results: The groups were similar in terms of age, gender, comorbidities, TNM (tumor, node, metastasis) stage, and laryngeal tumor extension. The incidence of pharyngocutaneous salivary fistula was 4.9% in group A and 19.8% in group B (p = 0.014).

Conclusions: Mechanical stapler closure of the pharynx after total laryngectomy was associated with a significant reduction in the incidence of pharyngocutaneous fistula compared with manual suture in selected cases.