Early videofluoroscopy after laryngectomy

Pharyngocutaneous fistula (PCF) is complication of laryngectomy. It leads to prolonged hospitalization and increased morbidity. The purpouse of this study is to evaluate the role of the videofluoroscopy (VFS) in the early postoperative period after laryngectomy.

The charts of 92 patients with laryngectomy for laryngeal cancer at MBAL“Sv. Marina” between july 2007 and december 2014 patients had had preoperative irradiation.

75 patients underwent a VFS with water-soluble contrast UROGRAFIN on day 6.8 ± 6.2. 16 of them had a second test on day 14,1 ± 25. 17 excluded patients (4 are tested with methylene blue dye, 9 are not examined, 2-lack of information, 1-pectoral flap, pharyngo-and gastrostoma.

57 patients had normal aspect of the hypopharynx on first VFS. Oral feeding-resumed on day 7,01 ± 2,02. None of them developed a PCF later. The mean postoperative hospital stay in this group was 11,6 days. 18 patients had abnormalities on VFS. 15 had a second VFS on average 14,1 days later and 6 had a third VFS on average 17 days. In this group oral feeding was resumed on da 12,4 ± 9,2. 4 patients developed PCF. The mean postoperative hospital stay in this group was 37 days. None of the patients without VFS developed PCF. The mean time to oral feeding and discharge were respectively 6,2 and 11,6 days.

VFS allows identifying defects of the hypopharyngeal plasty and postoperative management with nasogastric tube left in place, systemic antibiotics and local compressive dressing. VFS is highly informative examination that allows us to recognise insufficiency of the plasty. This allows us to assess whether to leave the NGT in place or to remove it and start the oral intake.

Publication History

Publication Date:
18 April 2018 (online)