PHARYNGOCUTANEOUS FISTULA FOLLOWING TOTAL LARYNGECTOMY AND POSTOPERATIVE VOMITING

The significance of post-operative vomiting as a risk factor in the de velopment of a pharyngocutaneous fistula was examined. The case record s of 50 consecutive patients undergoing laryngectomies (39 men, 11 wom en, average age 64 years) were examined, 17 also underwent a simultane ous radical neck dissection. A fistula developed in eight patients (16 %) and the median time to its diagnosis was 11 days (range 3-15 days). Several potential risk factors were examined including age, gender, p revious radiotherapy, TNM stage, differentiation of tumour, simultaneo us radical neck dissection and also the occurrence of vomiting post-op eratively. Ln this series of patients only vomiting in the early post- operative period appeared to be related to the development of a fistul a (regression summary: R2 = 0.6, t-value 5.6, P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subs equently developed a fistula. The median time of post-operative vomiti ng was 7.5 days (range 1-10 days) and the diagnosis of a fistula occur red at a mean of 1.2 +/- 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal rela tionship exists between vomiting and fistula development. However, if this is the case a potential means of decreasing the incidence of fist ulae following laryngectomy may be available.