Outcomes of mechanical stapling for postlaryngectomy open pharyngotomy closure

• DOI: 10.1002/lary.26208
• Publication Date: 2016-08-22T05:52:57Z
• Authors: Paul Paddle; Inna Husain; Lauren McHugh; Ramon Franco
• Keywords: Aged, 80 and over; Male; Laryngectomy; Equipment Design; Middle Aged; Survival Analysis; Disease-Free Survival; 3. Good health; Cohort Studies; 03 medical and health sciences; Surgical Staplers; 0302 clinical medicine; Surgical Stapling; Surgical Wound Dehiscence; Carcinoma, Squamous Cell; Humans; Female; Neoplasm Invasiveness; Laryngeal Neoplasms; Aged; Follow-Up Studies; Neoplasm Staging; Retrospective Studies

Objectives/HypothesisA total laryngectomy (TL) is performed as a primary or salvage therapy for laryngeal carcinoma. Pharyngotomy closure after TL is typically performed using manual sutures. Automatic stapling devices are routinely used in thoracoabdominal surgery, but have not been widely accepted for use in pharyngotomy closure. Previously described closed stapling techniques of pharyngeal closure do not allow direct evaluation of surgical margins and are limited to endolaryngeal disease. We describe an open technique for pharyngotomy closure using a mechanical stapling device.Study DesignRetrospective review.MethodsA review was conducted of 16 total laryngectomies performed from May 2008 to August 2015 utilizing an Ethicon Endopath ETS Compact‐Flex 45 stapler.ResultsSixteen patients (15 male, one female), mean age 69 years, received open TL (14 salvage, two primary) with endostapler pharyngeal closure and primary tracheoesophageal puncture (TEP). Surgical time averaged 218 minutes. Median time to swallowing was 4 days (range, 2–240 days) and mean hospital stay 6 days (range, 3–10 days). Fistula incidence was 31% (5/16) overall and 36% (5/14) in the postradiation patients.ConclusionsMechanical stapling is a simple method for postlaryngectomy open pharyngotomy closure. This technique allows evaluation of margins, easy primary TEP, and the opportunity for early swallowing and shorter hospital stays. In addition, it can be performed for closure of salvage laryngectomies with rates of fistula formation similar to that found in the literature using suture closure techniques. Future studies are necessary to compare oncological results and surgical complications between the open and closed stapling techniques and to traditional suture closure.Level of Evidence4 Laryngoscope, 127:605–610, 2017