Stapler Assisted Total Laryngectomy: A Prospective Randomized Clinical Study
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ORIGINAL ARTICLE
Stapler Assisted Total Laryngectomy: A Prospective Randomized Clinical Study Omar Ahmed1
•
Hesham Mustafa Abdel-Fattah2 • Hisham E. M. Elbadan2
Received: 27 July 2020 / Accepted: 20 August 2020 Association of Otolaryngologists of India 2020
Abstract Closure of the pharyngeal defect after total laryngectomy had been traditionally performed with manual suturing techniques that invert the mucosal edge this technique though effective, yet it is time-consuming. Recently the use of stapling devices to successfully close the pharyngeal defect after total laryngectomy has been advocated to shorten the operative time, especially in the high-risk cancer patients where a prolonged operative time is not preferred. The present study aimed at comparing stapler assisted total laryngectomy to suture closure total laryngectomy in a prospective randomized manner. This is a prospective clinical study conducted on 60 patients undergoing total laryngectomy at Alexandria Main University Hospital, Egypt. Patients with tumor extension to the hypopharynx or base of the tongue were excluded from the study. The surgical time is reduced with shorter hospital stays and no increase in postoperative complications rate. The use of the stapler is technically easy to perform and as equally as effective as the traditional neopharyngeal suturing techniques in patients undergoing total laryngectomy.
& Omar Ahmed [email protected] Hesham Mustafa Abdel-Fattah [email protected] Hisham E. M. Elbadan [email protected] 1
ENT Registrar at East Kent Hospitals University NHS Foundation Trust, Kent, UK
2
Department of Otorhinolaryngology and Head& Neck Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
Keywords Total laryngectomy Stapler Pharyngocutaneous fistula Neopharynx Closure Operative time
Introduction Although Total laryngectomy (TL) is an excellent oncologic surgical procedure for patients who have laryngeal cancer, it can be associated with several complications. Pharyngocutaneous fistula (PCF) is the most frequent postoperative complication following TL. PCF occurs when pharyngeal repair fails and saliva leaks [1] with an incidence varying from 5 to 65% [1]. Its occurrence leads to increased morbidity, prolonged hospitalization time, delayed initiation of postoperative radiotherapy, and increased treatment costs [2]. Accordingly, pharyngeal closure is an essential step during the total laryngectomy procedure and requires special attention from the surgeon [3]. The requirements for neopharyngeal closure are the absence of tension on wound edges and the possibility to preserve mucosal viability, to create a waterproof barrier to extravasation of pharyngeal secretions into the neck [4]. Closure of the neopharynx after total laryngectomy had been traditionally performed with manual suturing techniques that invert the mucosal edges. This concept of mucosal edge inversion was thought to decrease the rate of PCF [4]. However, with the development of anastomotic staplers used in gast
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