Post-Laryngectomy Stricture and Pharyngocutaneous Fistula: Review of Techniques in Primary Pharyngeal Reconstruction in Laryngectomy.

ObjectiveThe purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post‐laryngectomy stricture after laryngectomy.Study DesignRetrospective Chart Review.MethodsWe retrospectively reviewed a total of 151 patients over a 20‐year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo‐cutaneous fistula (PCF) and post‐laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data.ResultsThe overall PCF and post‐laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t‐type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non‐salvage t‐type closure remained significantly better than both salvage laryngectomy groups (t‐type, P=.033, vertical, P=.037), while non‐salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63).ConclusionOur study supports the role of t‐type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post‐laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.