Early oral feeding following total laryngectomy

Introduction:

Pharyngocutaneous fistula is the most common complication following a laryngectomy which increases the pressure on the patient, the surgeon and the healthcare system. The common practice is to start feeding 7 – 10 days post-operatively. There are different opinions among authors as some of the studies shows no significant difference between early and delayed oral feeding with regards to the formation of pharyngocutaneous fistulae, while others recommend further delaying the oral feed, in particular those with prior radiation, due to their delayed wound healing. This article will review the feasibility of early oral feeding following total laryngectomy.

Methods:

In Kaspela ENT department, there were 32 selected patients undergoing total laryngectomy who started early oral feeding. The pharynx in all cases was closed using 3 – 0 breaded suture, in two layers via 'I' formed sunning suture. Patients started oral intake of clear liquids on 48th hour and nutritional shake on the 72nd hour and returned to normal diet on the 5th day after surgery.

Results:

There was only 2 cases out of 32 where fistula was observed. One of the patient was 62 had a neck dissection and the other who was 83 did not.

Conclusions:

Our experience is in concordance with the published data and we always aim to start early feeding. However, one needs be vigilant with those who have received radiation prior to surgery as these patients are indeed at a higher risk of fistulae formation.

Publication History

Publication Date:
23 April 2019 (online)