Endoscopic repair of pharyngocutaneous fistula following laryngectomy

Introduction: Pharyngocutaneous fistula (PCF) is a typical complication after total laryngectomy, which is predominantly conservatively managed. A surgical treatment is required when the fistula has a large orifice and/or a substantial loss of surrounding soft tissue is present. Objective: To report a new endoscopic surgical approach for closure of post-laryngectomy PCF using autologous fat graft injection. Case report: A 61-year old male presented with a late PCF two years after total laryngectomy with partial resection of the tongue base for advanced laryngeal carcinoma with infiltration of the hypopharynx. Already at the time of the initial surgery the postopertive course was complicated with early PCF, managed conservatively. Rhinopharyngoscopy with a flexible scope revealed a well identifiable epithelized opening (4x4 mm) in the midline at the junction between the base of the tongue and the neohypopharynx. Further evaluation with CT and barium swallow radiographs showed a fistula between the neopharynx and the skin at the C2-C4 level. An endoscopic surgical repair was performed. The neohypopharyx was approached with the Weerda diverticuloscope. Fat tissue harvested from the abdomen was injected into the area surrounding the pharyngeal opening of the fistula. Further the opening was sclerosed and sutured. The repair was successful and for the next 6 months the patient had normal oral feeding without any signs of leakage or inflammation around the former PCF. Conclusion: In conservative therapy-refractory cases of PCF surgical intervention is mandatory. In well selected cases a combination of endoscopic approach and autologous fat injection can be used.Der Erstautor gibt keinen Interessenkonflikt an