Pharyngocutaneous Fistula Following Total Laryngectomy in Sokoto, Northwestern Nigeria

Abstract

Aims: This study aims to determine the prevalence of pharyngocutaneous fistula and the risk factors in this environment. Study Design: Retrospective study. Place and Duration of Study: Department of Otorhinolaryngology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria between January 2006 and December 2017. Methodology: The case record of all patients who had total laryngectomy were retrieved from the Hospital Record Department and reviewed.   Partial laryngectomy and incomplete/missing case file were excluded. Data obtained were patients' age, gender, co-morbidities (like diabetes mellitus and hypertension), laboratory investigations, tumour site, histology and stage, type of laryngectomy, pre-operative radiotherapy, surgical technique, time of fistula formation, the days before the commencement of oral diet and length of hospital stay. The data analysed with IBM SPSS version 21.0 and the statistical significance calculated with GraphPad Instat 3 Software. A P value ≤ 0.05 was considered statistically significant. Results: The total number of patients who had total laryngectomy during the study period was 30, comprising 26 (86.7%) males and 4 (13.3%) females with a male to female ratio of 6.5:1. The average age was 58 years (range 29-80). The average duration of hospitalization was 29.5 days (range 19-48). The prevalence of pharyngocutaneous fistula among the patients was 8 (26.7%), and it occurred exclusively in the male. The majority (62.5%) of the pharyngocutaneous fistula occurred before initiation of oral diet and within the first ten postoperative days. The identified risk factors for the observed pharyngocutaneous fistula were supraglottic and transglottic tumour sites, well differentiated squamous cell carcinoma and T3/T4 tumour stage. However, none of these risk factors was statistically significant. The PCF was successfully managed conservatively, but the patients had prolonged hospitalization and initiation of the oral diet. Conclusion: The prevalence of pharyngocutaneous fistula in this study was 26.7%, and the identified risk factors were not statically significant. There were prolonged hospitalization and initiation of oral diet with obviously increased morbidity, cost, and delayed rehabilitation.