Post-laryngectomy pharyngocutaneous fistula--a still unresolved problem.

Fifty-six total laryngectomy cases are presented with special reference to post-operative fistula formation. All these patients were operated upon at the Department of Otorhinolaryngology at the Bnai Zion Medical Centre by one surgeon over a 16-year period, from 1976-1992. The incidence of fistula was 12.5 per cent. This paper could not verify reports that any specific factors were significantly related to fistula formation, although there was a preponderance of fistulas in patients presenting with late stage tumours. No relationship was found with rate of infection, age, or between previous neck irradiation (ranging from 5500 to 7000 cGy) and fistula formation in the patient population. If a fistula occurs, the administration of oral solid food keeping the nasogastric tube in place for administration of fluids may lead to spontaneous closure of the fistula, with no need for secondary surgical repair.