1. Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy.
- Author
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Narayan, M, Limbachiya, S, Balasubramanian, D, Subramaniam, N, Thankappan, K, and Iyer, S
- Subjects
DEGLUTITION disorders ,FISTULA ,FLUOROSCOPY ,LARYNGECTOMY ,RISK assessment ,SKIN diseases ,SURGICAL complications ,CONTRAST media ,RETROSPECTIVE studies ,CASE-control method ,DESCRIPTIVE statistics ,DRUG administration ,DRUG dosage ,THERAPEUTICS - Abstract
Objectives: Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae. Methods: A retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy. Results: In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively. Conclusion: Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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