Endoscopic observation of pharyngeal mucosal suture healing process after total laryngectomy: case series

Abstract

Background

Pharyngocutaneous fistula (PCF), a major complication of total laryngectomy, is caused by pharyngeal repair failure.

Objective

Assess the usefulness of endoscopic observation of the pharyngeal suture’s healing process for the early detection of PCF development.

Methods

Pharyngeal mucosal sutures were endoscopically observed postoperatively in patients who underwent total laryngectomy with primary closure.

Results

Postoperatively, a white coat adhered to the pharyngeal mucosal suture of all patients. In most cases, the white coat gradually receded, which was considered to be a normal healing process. Thickening of the white coat and/or dehiscence of surgical wound were interpreted as ‘poor healing conditions’. Three cases were judged to have developed poor healing conditions of the pharyngeal mucosal suture and one patient developed PCF. The other two patients did not develop PCF, possibly due to early detection of ‘poor healing condition’ and conservative approach, such as discontinuation of oral intake.

Conclusions

Postoperative poor healing conditions of the pharyngeal mucosal suture may be precursors to PCF development. Endoscopic observation enables early detection of these conditions and may enable the prevention of PCF.

Chinese Abstract

背景：咽皮肤瘘（PCF）是全喉切除术的主要并发症, 是由咽部修复失败引起的。

目的：评估内镜观察咽缝合线愈合过程的有用性, 用于PCF发生的早期检测。

方法：对接受了全喉切除术并一期关闭的患者的术后咽黏膜缝合线进行内镜观察。

结果：术后所有患者咽部粘膜缝合线均粘附有白色膜。在大多数情况下, 白色膜会逐渐退去, 这被认为是正常愈合过程。 白色膜增厚和/或手术伤口开裂被解释为“不良愈合状况”。 3例被判定为咽粘膜缝合线不良愈合状况, 一名患者发生 PCF。 另外两名患者没有发生 PCF, 可能是由于早期发现“不良愈合状况”并采取保守措施, 例如停止口服摄入。

结论：咽黏膜缝合线术后不良愈合状况可能是PCF 发生的前兆。 内窥镜观察可以及早发现这些状况, 并可能采取 PCF 的预防措施。

Keywords:

• Pharyngocutaneous fistula
• surgical complications
• total laryngectomy
• endoscopic observation
• healing process

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available due to protection of personal information but are available from the corresponding author on reasonable request.