Stellenwert der ösophagographie und des Methylenblau-Schlucks zur Erkennung okkulter pharyngokutaner Fisteln nach totaler Laryngektomie

Introduction Pharyngocutaneous fistulas (PCF) are the most common surgical complication after laryngectomy (LE). Although there is no official recommendation in this regard, an esophagography (EG) or a methylene blue swallow test (MBS) is usually performed postoperatively to detect PCF prior to oral nutrition intake. In this study, we analyzed the diagnostic value of both methods for the detection of occult PCF after LE.

Material and methods Clinical data of 119 patients who underwent primary or salvage LE or laryngopharyngectomy at the Marburg University Hospital from 2005 till 2021 were analyzed retrospectively. A total of 69 patients underwent a EG (n=33) or a MBS (n=36) for evaluation of PCF.

Results 22 of 119 patients (18.5%) developed a PCF. 14 of the 22 patients with a PCF underwent an EG (n=11) or MBS (n=3). By 6 of those 14 patients, the examination was performed to evaluate an already clinically diagnosed PCF. By 5 patients, the diagnosis was performed as a follow-up examination of a previously treated PCF. From the 69 patients examined either by EG or MBS, a clinically occult PCF could be diagnosed in only 3 cases (4.3%), twice by a EG and once by a MBS. False positive or false negative findings were not observed.

Conclusion EG and MBS are effective methods for the evaluation of a PCF after LE. A detection of occult PCF by means of EG and MBS appears to be rare. In this regard, it remains unclear whether an early detection is beneficial for further treatment. Therefore, the routine performance of those diagnostics should be critically discussed.

Key Words Pharyngocutaneous fistula, Esophagography, Laryngectomy

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Artikel online veröffentlicht:
12. Mai 2023