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Reducing the rate of fistula: does a fibrin sealant act as an adjunct in pharyngeal closure? A two-centre experience

Published online by Cambridge University Press:  03 August 2020

R Roplekar Bance ,
P Coyle ,
A Dias ,
P Kothari ,
K Shah ,
J Thaj  and
F Vaz
R Roplekar Bance*
Affiliation:
Department of ENT, Luton and Dunstable University Hospital NHS Foundation Trust, UK
P Coyle
Affiliation:
Department of ENT, Luton and Dunstable University Hospital NHS Foundation Trust, UK
A Dias
Affiliation:
Department of ENT, Luton and Dunstable University Hospital NHS Foundation Trust, UK Department of Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, UK
P Kothari
Affiliation:
Department of ENT, Luton and Dunstable University Hospital NHS Foundation Trust, UK
K Shah
Affiliation:
Department of Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, UK
J Thaj
Affiliation:
Department of Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, UK
F Vaz
Affiliation:
Department of Head and Neck Surgery, University College London Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mrs Rujuta R Bance, Department of ENT, Luton and Dunstable University Hospital NHS Foundation Trust, UK E-mail: Rujuta.bance@nhs.net
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Abstract

Background

Pharyngocutaneous fistula is a troublesome complication. Recently, synthetic materials such as fibrin sealant have been used as a secondary measure to treat fistula. This work assessed whether the primary use of fibrin sealant can reduce the rate of fistula.

Method

A retrospective review of 50 cases from 2 centres was completed. Tisseel was an adjunct to primary closure in all cases.

Results

In the first centre, 3 out of 34 cases developed pharyngocutaneous fistula (fistula rate of 9 per cent). All three were salvage cases. In the second centre, 0 out of 16 cases developed a fistula.

Conclusion

The incidence of pharyngocutaneous fistula post-radiation and post-chemoradiotherapy in laryngectomy cases has been quoted as 23 per cent and 34 per cent respectively. This study represents the first patient series on the use of fibrin sealant as an adjunct in primary closure following laryngectomy. The results are promising, encouraging the use of Tisseel as an adjunct to meticulous closure.

Keywords

LaryngectomyPharyngectomyFistulaFibrin Tissue Adhesive
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 7 , July 2020 , pp. 623 - 625
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Mrs R R Bance takes responsibility for the integrity of the content of the paper

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