GASTROESOPHAGEAL REFLUX PROPHYLAXIS DECREASES THE INCIDENCE OF PHARYNGOCUTANEOUS FISTULA AFTER TOTAL LARYNGECTOMY

Pharyngocutaneous fistula is a serious complication after laryngectomy . Gastric fluid is known to cause severe laryngopharyngeal injury and poor mucosal healing. This study was designed to evaluate the effects of a gastroesophageal reflux prophylaxis regimen on the incidence of f istula after laryngectomy. Twenty-one consecutive patients were entere d in the study. Patients with positive resection margins were excluded from the overall analysis. All patients had a Connell's two-layer clo sure of the pharynx with absorbable suture, suction drainage of the ne ck, postoperative tube feeding, and prophylactic antibiotics. All pati ents were started on an antireflux regimen postoperatively composed of continuous tube feeds, intravenous ranitidine, and intravenous metocl opramide hydrochloride. Patients were followed postoperatively with Ga strografin swallows and clinically for 8 weeks. The control group cons isted of retrospectively studied patients managed identically except f or the antireflux prophylaxis. The two groups were well matched for fa ctors reported to influence the rate of pharyngocutaneous fistula form ation. The control group had six fistulae (26%) and an average of 16.5 days of hospital stay. The study group had no fistulae and an average of 11.5 days of hospital stay (P = .02). This study suggests that gas troesophageal reflux may predispose to fistula formation after larynge ctomy and that mechanical and pharmacological prophylaxsis decreases p ostoperative morbidity and length of hospital stay.