Stapler Versus Manual Suturing for Pharyngeal Closure in Total Laryngectomy.

Background: Laryngeal carcinoma is not uncommon worldwide. We conducted this study to comprehensively compare the outcome of stapler versus conventional suturing in total laryngectomy primary or salvage.

Patients and methods: This is a retrospective study conducted in our tertiary institute from 2015 to 2022 involving patients diagnosed with laryngeal carcinoma who underwent total laryngectomy either primary or salvage. We divided patients into 4 groups: primary or salvage laryngectomy, closed with stapler or manual suturing. The reported outcomes included : operative time, length of hospital stay, start of oral feeding, incidence of pharyngocutaneous fistula, positivity of surgical margins, and surgical site infection. Patients with multiple comorbidities and those requiring a flap for pharyngeal closure were excluded .

Results: A total of 91 patients were included in our study. Pharyngocutaneous fistula rate was 19% in conventional patient group in comparison to 6.7% in stapler group for primary total laryngectomy while it was 12.5% for salvage with stapler and 25% for salvage with conventional. Hospital stay was 6 ± 1.5 days for stapler and 11.4 ± 2.9 days for conventional suturing in primary laryngectomy. It was 8.8 ± 1.3 days for stapler and 13.1 ± 1.8 for conventional suturing in salvage laryngectomy. There was highly significant difference found as regard mean operative time, start of oral feeding and hospital stay in favor of stapler use.

Conclusion: Stapler use in total laryngectomy is is a simple, fast, and effective technique with tension free watertight closure, better hemostasis, less contamination of surgical field than manual suturing.