Pharyngocutaneous fistula after laryngeal surgery: The role of the barium swallow

Pharyngocutaneous fistula is one of the major complications following laryngeal surgery. Prior to 1979, patients undergoing laryngectomy at the University of Minnesota were not fed until 9 or 10 days postoperatively if unirradiated and 12 to 14 days if irradiated. Most fistulas were apparent by 14 days postoperatively, but occasionally a patient would develop a fistula as late as a month postoperatively. Starting in 1979, in an attempt to decrease the length of hospitalization as well as prevent fistula formation, routine barium-swallow videoesophagograms were obtained 7 days postoperatively in all laryngectomy patients. If the results were considered normal, the nasogastric tube was removed and oral feedings were started. Of a total of 45 patients undergoing wide-field laryngectomy, there were 3 clinical fistulas and 3 radiologic fistulas. Following this protocol, we shortened the average postoperative hospitalization by 2 days without an increase in the rate of fistulization.