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Cureus Sep 2021Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this... (Review)
Review
Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end. Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.
PubMed: 34707956
DOI: 10.7759/cureus.18181 -
Journal of Clinical Medicine May 2022The supraclavicular artery island flap (SCAIF) is a reliable, easy-to-harvest and versatile fasciocutaneous flap that can be used for pharynx reconstruction. Instead of... (Review)
Review
The supraclavicular artery island flap (SCAIF) is a reliable, easy-to-harvest and versatile fasciocutaneous flap that can be used for pharynx reconstruction. Instead of free flaps, it requires no microsurgical technique, reduced operating time and postoperative care, making it an ideal option, especially during the COVID-19 pandemic. The primary aim of our study was to present two cases of a total laryngectomy and reconstruction with the SCAIF during the pandemic. The secondary aim was to review the literature concerning surgical techniques, complications and contradictions of the SCAIF for pharynx reconstruction. A literature search was performed using the PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Scopus and Cochrane Library databases, using MeSH terms: larynx AND reconstruction AND flap. Ten full-text articles comprising 92 patients with 93 supraclavicular flaps were included. The patch graft, pharyngeal interposition graft, tubularization or "U"-shaped SCAIF were the main surgical techniques. Pharyngocutaneous fistula was the most frequent postoperative complication, especially in patients with previous radiotherapy, but just 19% of patients required secondary intervention. The lack of donor-site morbidity, low flap loss rates and stenosis rates favored this reconstructive option. This review underlined that the SCAIF has comparable results with other reconstructive options, consolidating this flap in the workhorse of pharynx reconstruction.
PubMed: 35683510
DOI: 10.3390/jcm11113126 -
International Journal of Nanomedicine 2022Pharyngocutaneous fistula is the most common complication after total laryngectomy and is difficult to heal. Although conservative treatment and surgical repair are... (Review)
Review
Pharyngocutaneous fistula is the most common complication after total laryngectomy and is difficult to heal. Although conservative treatment and surgical repair are effective, they often take longer and additional trips to the operating room, which undoubtedly increases the financial burden on patients. Especially in combination with diseases such as diabetes and hypertension, which affect the efficacy of surgery. Adding growth factors into the repair material can promote fibroblast proliferation, angiogenesis, and accelerate wound healing. A substantial number of studies have shown that a type of nanoscale extracellular vesicle, called exosomes, facilitates organization repair by promoting blood vessel production, protein polysaccharides, and collagen deposition, thereby representing a new type of cellular therapy. At present, there is little research on the application of exosomes in pharyngocutaneous fistula regeneration after total laryngectomy. In this review, we summarize the biological characteristics of exosomes and their application in biomedical science, and highlight their application prospects in pharyngocutaneous fistula regeneration after total laryngectomy.
Topics: Cutaneous Fistula; Exosomes; Humans; Laryngeal Neoplasms; Laryngectomy; Pharyngeal Diseases
PubMed: 36118178
DOI: 10.2147/IJN.S372042 -
Cureus Mar 2021Esophagectomy is the mainstay surgical treatment for esophageal carcinoma. The operation can be complicated by an anastomotic stricture, anastomotic leak, recurrent...
Esophagectomy is the mainstay surgical treatment for esophageal carcinoma. The operation can be complicated by an anastomotic stricture, anastomotic leak, recurrent laryngeal nerve injury, conduit ischemia, and chylothorax. Rarely, esophagectomy can be complicated by fistula formation between the gastrointestinal tract and the nearby structures. We describe a case of esophagopericardial fistula after esophagectomy. A 50-year-old man presented to the emergency room with a chest pain of two-week duration associated with sweating, chills, and poor appetite. He was diagnosed with stage III esophageal adenocarcinoma four months ago. He had received neoadjuvant chemotherapy followed by distal esophagectomy, partial gastrectomy, and placement of a jejunostomy tube one month before presentation. Cardiovascular examination was significant for jugular venous distention and distant heart sounds. Chest CT angiography showed pneumomediastinum concerning for anastomotic leak. Esophagram finally confirmed an esophagopericardial fistula. A drain was placed into the pericardial space followed by emergent esophageal stent placement. Eventually, he underwent a cervical esophagostomy and placement of a jejunostomy tube. The patient was later discharged home in a stable condition. In conclusion, esophagopericardial fistula is a rare adverse event of esophagectomy. Esophageal stenting could be useful as a temporary or definite treatment.
PubMed: 33842130
DOI: 10.7759/cureus.13753 -
Frontiers in Pediatrics 2020Review techniques for intraoperative recurrent laryngeal nerve (RLN) monitoring during pediatric surgery for esophageal atresia, tracheoesophageal fistula,... (Review)
Review
Review techniques for intraoperative recurrent laryngeal nerve (RLN) monitoring during pediatric surgery for esophageal atresia, tracheoesophageal fistula, tracheobronchomalacia, and cardiac surgery. Literature was reviewed for reports of intraoperative recurrent laryngeal nerve monitoring in cervical, thoracic, and cardiac surgical procedures which place the RLNs at risk for injury. Review paper. The RLN is at risk during pediatric surgery for esophageal atresia, tracheoesophageal fistula, tracheobronchomalacia, and cardiac surgery. Intraoperative nerve monitoring has decreased rates of RLN injury in thyroid surgery. Intraoperative RLN monitoring techniques appropriate for pediatric surgery are discussed, including endotracheal tubes with integrated surface electrodes, adhesive surface electrodes for smaller endotracheal tubes, endolaryngeal electrodes, and automatic periodic continuous intra-operative stimulation. Multiple techniques exist to monitor the RLN in children undergoing cervical, cardiac, and thoracic surgery. Monitoring the RLN during procedures that place the RLNs at risk may help decrease the rate of RLN injury.
PubMed: 33330282
DOI: 10.3389/fped.2020.587177 -
Maedica Jun 2014In a period in which therapeutic approaches for malignant laryngeal tumors are focused on the principle of "organ preservation", total laryngectomy is a well coded... (Review)
Review
In a period in which therapeutic approaches for malignant laryngeal tumors are focused on the principle of "organ preservation", total laryngectomy is a well coded surgical procedure, addressed to the advanced laryngeal cancer which is not suitable for conservative techniques or in case of their failure. The main objective of this work is to summarize the important events that have marked the evolution of this surgical technique to the current formula. Also this paper aims to identify, in our own casuistry, some elements of strategy and surgical technique required, in our opinion, for a successful therapeutic intervention. The fundamental significance of the study is that we must learn from the past, perform our surgeries at contemporary standards and look to the future for new solutions and approaches of the advanced laryngeal malignancies.
PubMed: 25705281
DOI: No ID Found -
Journal of Thoracic Disease Mar 2016Tracheal resection and reconstruction (TRR) and laryngotracheal resection and reconstruction (LTRR) is commonly performed for post-intubation tracheal stenosis, tracheal... (Review)
Review
Tracheal resection and reconstruction (TRR) and laryngotracheal resection and reconstruction (LTRR) is commonly performed for post-intubation tracheal stenosis, tracheal tumor, idiopathic laryngotracheal stenosis (ILTS), and tracheoesophageal fistula (TEF). Ninety-five percent of patients have a good result from surgery. Complications occur in ~20% of patients, of which half are anastomotic complications. Complications include granulation tissue formation, restenosis of the trachea, anastomotic separation, TEF and tracheoinnominate fistula (TIF), wound infection, laryngeal edema, and glottic dysfunction. Risk factors for anastomotic complication include diabetes, reoperation, previous tracheal appliance, and long-segment tracheal resection. Bronchoscopy should be part of the diagnostic workup when a complication is suspected. Anastomotic separation-the most feared complication of tracheal surgery-may present subtly with stridor and wound infection, or with respiratory distress and extremis. Prompt management is required to prevent devastating consequences. The airway should be secured, bronchoscopy should be performed to address the degree of separation, and the anastomosis should be revised if needed, usually with the addition of t-tube or tracheostomy. Anastomotic complications that are managed aggressively typically yield good results. More than half of such patients will eventually have a satisfactory airway. However, an anastomotic complication is associated with a thirteen-fold increase in the risk of death following tracheal resection.
PubMed: 26981267
DOI: 10.3978/j.issn.2072-1439.2016.01.86 -
Indian Journal of Surgical Oncology Dec 2022Pharyngocutaneous fistula (PCF) is the most common complication which significantly increases morbidity. High-level evidence is lacking that determines the PCF rates in... (Review)
Review
UNLABELLED
Pharyngocutaneous fistula (PCF) is the most common complication which significantly increases morbidity. High-level evidence is lacking that determines the PCF rates in the primary laryngectomy. The main objective of this study was to systematically identify the factors leading to the PCF formation in primary laryngectomy. Human studies reporting at least one risk factor for developing PCF in patients undergoing primary total laryngectomy for laryngeal cancer were included. PubMed, EMBASE, and Cochrane databases were searched for the data extraction. Risk of bias assessment tool for non-randomized trial tool was used. Cochrane's test and Higgin's -heterogeneity was applied. The Mantel-Haenszel and DerSimonian Laird method was employed. Odds ratio was calculated for each risk factor, a -value < 0.05 was considered as statistically significant. PROSPERO registration CRD42021248382. The meta-analysis comprised a total of 2446 patients in 14 included non-randomized studies. The among the analyzed risk factors-comorbidities (OR 2.781, R: 1.892-4.088, < 0.001), site of tumor (OR 4.485, R: 3.003-6.699, < 0.001), low pre-operative hemoglobin (OR 3.590, R: 2.130-6.050, < 0.001), low pre-operative albumin (OR 2.833, R: 1.596-5.031, < 0.001), utilization of surgical staplers (OR 0.172, R: 0.064-0.460, < 0.001) (protective effect), positive mucosal margin (OR 4.92 R: 1.90-12.75, = 0.001). The risk factors for PCF in patients undergoing primary TL included comorbidities, hypopharyngeal involvement, pre-operative hemoglobin and albumin, stapler usage, and positive mucosal margin. Level of Evidence - III.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13193-022-01581-z.
PubMed: 36687232
DOI: 10.1007/s13193-022-01581-z -
Pediatric Surgery International May 2021H type tracheoesophageal fistula (H-TEF) is a rare congenital anomaly. Management may be complicated by late diagnosis and variation(s) in the therapeutic strategy. A...
BACKGROUND
H type tracheoesophageal fistula (H-TEF) is a rare congenital anomaly. Management may be complicated by late diagnosis and variation(s) in the therapeutic strategy. A systematic review of published studies explores the utility of diagnostic studies, operations and postoperative complications.
METHODS
Medline and PubMed database(s) were searched for ALL studies reporting H-TEF during 1997-2020. Using PRISMA methodology, manuscripts were screened for eligibility and reporting.
RESULTS
Forty-seven eligible studies were analysed. Primary diagnosis varied widely with surgeons performing oesophagography and trachea-bronchoscopy. Preoperative localisation techniques included fluoroscopy, guidewire placement and catheterisation. A cervical approach (209 of 272 cases), as well as thoracotomy, thoracoscopy and endoscopic fistula ligation, were all described. Morbidity included fistula recurrence (1.7%), leak (2%), tracheomalacia (3.4%) and respiratory sequelae (1%). The major adverse complication in all studies was vocal cord palsy secondary to laryngeal nerve injury (18.5%) yet strikingly few centres routinely reported undertaking vocal cord screening pre or postoperatively.
CONCLUSION
This study shows that paediatric surgeons record low volume activity with H type tracheoesophageal fistula. Variation(s) in clinical practice are widely evident. Laryngeal nerve injury and its subsequent management warrant special consideration. Care pathways may offset attendant morbidity and define 'best practice.'
Topics: Bronchoscopy; Female; Humans; Infant, Newborn; Male; Postoperative Complications; Postoperative Period; Recurrent Laryngeal Nerve Injuries; Retrospective Studies; Thoracoscopy; Thoracotomy; Trachea; Tracheoesophageal Fistula; Tracheomalacia
PubMed: 33474597
DOI: 10.1007/s00383-020-04853-3