Pharyngcutaneous fistula after total laryngectomy: treatment modalities and our experiences

Aim: The aim of this study is to share our experience and treatment modalities in pharyngocutaneous fistulas that can be seen after primary and post-radiotherapy salvage total laryngectomy. Material and Method: The records of patients who underwent total laryngectomy in our clinic between February 2012 and December 2021 were reviewed retrospectively. The patients’ age, preoperative radiotherapy history, postoperative fistula development, gastrostomy opening, treatment modality, and hospital stay were examined. Results: A total of 115 patients, 81 of whom were primary and 34 of whom had a history of radiotherapy, were evaluated in the study. Pharyngocutaneous fistula developed in a total of 20 patients in 10 primary patients and 10 patients with a history of preoperative radiotherapy. The mean hospital stay was 10 days for patients who did not develop fistula. The mean hospital stay was 27 days between days 21 and 36 in primary patients with fistula, and it was 46 days between days 34 and 68 in patients with a history of radiotherapy who developed fistula. While only 1 of the primary patients underwent reconstruction with a pectoralis major muscle flap because the fistula did not close despite local dressing and local skin flaps, this number was 7 in patients with a history of radiotherapy. Conclusion: The presence of a history of radiotherapy before total laryngectomy increases the risk of laryngocutaneous fistula development, increases the need for myocutaneous flaps, and increases the length of hospital stay, resulting in increased comorbidity. Pharyngocutaneous fistula development is neither an important comorbidity nor religion.