Incidence of salivary fistulas subject to the timing of oral feeding afterlaryngectomy

Background and objective. A pharyngocutaneous fistula is the most common co mplication after total laryngectomy. In Germany, a traditional recommendati on is to use a nasogastric tube for feeding for 10-14 days postoperatively because many surgeons believe that oral feeding after surgery contributes t o fistula development. However, there is no international agreement about w hen to begin oral feeding after total laryngectomy. Some authors begin oral feeding between the 1st and 4th postoperative day without any nasogastric tube, while others using a nasogastric tube delay oral feedings until 7-14 days after surgery. The aim of the present study was to investigate the rel ationship between the timing of oral feeding and the development of fistula s after total laryngectomy. Patients/methods. In a prospective trial with 42 consecutive patients who u nderwent laryngectomy, oral feeding was started on different postoperative days between the 1st and the 10th. Most patients were selected randomly for the different postoperative days. Furthermore, other potential risk factor s predisposing to fistula formation were analyzed retrospectively. Results. Five fistulas occurred in the total group (12%). Early postoperati ve oral feeding does not increase the incidence of fistulas. The fistula ra te was only 9% in patients fed orally in the ist postoperative week. The an alysis of further risk factors for fistula formation showed only a signific ant correlation between type of resection and fistula occurrence (extended laryngectomy with partial pharyngectomy vs standard laryngectomy; p = 0.018 ). Conclusions. Our results indicate that early oral feeding in the Ist postop erative week does not influence fistula formation after laryngectomy.