Pharyngocutaneous Fistula after Laryngeal Surgery: The Role of the Barium Swallow

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Abstract
Pharyngocutaneous fistula is one of the major complications following laryngeal surgery. Prior to 1979, patients undergoing laryngectomy at the University of Minnesota were not fed until 9 or 10 days postoperatively if unirradiated and 12 to 14 days if irradiated. Most fistulas were apparent by 14 days postoperatively, but occasionally a patient would develop a fistula as late as a month postoperatively. Starting in 1979, in an attempt to decrease the length of hospitalization as well as prevent fistula formation, routine barium-swallow videoesophagograms were obtained 7 days postoperatively in all laryngectomy patients. If the results were considered normal, the nasogastric tube was removed and oral feedings were started. Of a total of 45 patients undergoing wide-field laryngectomy, there were three clinical fistulas and three radiologic fistulas. Following this protocol, we shortened the average postoperative hospitalization by 2 days without an increase in the rate of fistulization.