Sutura mecánica de la faringe con punción traqueoesofágica en laringectomía totalNuestros primeros casos

Abstract

Introduction and objective: Closure of the pharynx is one of the key steps in total laryngectomy. The appearance of pharyngocutaneous fistulas is one of the most frequent complications of this surgery, whose incidence can reach 50% according to some authors. The introduction of mechanical suture in our area could represent a before and after in this surgery, since it seems to reduce the incidence of complications, as well as reduce surgical time and hospital stay. The objective of this study is to present our initial experience in performing mechanical suture for pharyngeal closure in patients undergoing total laryngectomy, and to demonstrate the possibility of inserting a voice prosthesis through fistuloplasty in the same surgical act. Method: We present a serie of accumulated cases in our center since the technique began to be used 2 years ago. The surgical technique is described, as well as the surgical indication, type of mechanical suture used, surgical time and performance or not of primary tracheoesophageal puncture, as well as data related to postoperative evolution (beginning of oral intake and appearance of pharyngocutaneous fistula). Results: During the study period, a total of 14 laryngectomies were performed, in 9 of which mechanical closure of the pharynx was chosen. All patients were male, with an average age of 68,3 years. Four patients underwent total laryngectomy as primary treatment and the remaining five underwent salvage surgery after treatment with radiotherapy with or without chemotherapy. In 66,7% hyoid resection was performed. 44,4% of the patients received hyperproteic nutrition prior to surgery. In 5 of the patients, tracheoesophageal fistuloplasty was performed with insertion of a Provox voice prosthesis at the time of surgery. The median time to onset of oral tolerance was 13 days. Pharyngocutaneous fistula occurred in 33,3% of patients. Discussion: Since the first total laryngectomy performed by Billroth in 1873, several advances have been made in the surgical technique in order to reduce its possible complications. Pharyngeal closure has always been a challenge, with a high incidence of pharyngocutaneous fistulas, which significantly increase costs and hospital stays. In recent years, the use of mechanical suture has become popular. Although initially we performed the fistuloplasty in a second stage, in recent cases we placed the voice prosthesis in the same surgical act, without observing a higher incidence of pharyngocutaneous fistula. Conclusions: Although our experience is still limited, in view of our results we believe that mechanical suture with concomitant tracheoesophageal puncture and voice prosthesis insertion is at least as safe as direct closure with manual suture.