Pharyngocutaneous fistula is a common and troublesome postoperative complication after
total laryngectomy. The objective of this report was to determine the incidence, predisposing
factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in
our department and to describe the management of the complication.
The medical records of 146 consecutive patients who underwent laryngeal surgery for
squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had
similar preoperative/postoperative care. We studied a number of factors that could influence
fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy,
previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure
(T vs. vertical), concurrent neck dissection, suture material, clinical stage, histologic grade, and
experience of surgeon (consultant vs. resident).
A pharyngocutaneous fistula was observed in 13% (19/146) of the patients within a mean time
of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 (89%)
patients whereas a surgical closure was necessary in two. One patient required surgical closure by
direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another
one. Our findings showed that fistula formation was significantly more common in patients who
received previous radiotherapy or who had positive surgical resection margins or had a systemic
disease. The mean healing time was 26 days.
We concluded that pharyngocutaneous fistula remains a troublesome complication of the early
postoperative period after total laryngectomy. There are many conflicting reports in the literature
concerning the predisposing factors, but our data showed that the presence of systemic diseases,
previous radiotherapy, and positive surgical margins can all be important predisposing factors, or
at least underlying causes. Our experience confirmed that most fistulas can be successfully
managed with conservative treatment
