Teaima Ahmed Abdelmoneim, Mostafa Badr Eldin, Nabil Khaled Mohamed, Mady Ossama Mustafa
Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Ann Otol Rhinol Laryngol. 2025 May;134(5):320-325. doi: 10.1177/00034894241308403. Epub 2024 Dec 20.
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.
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 .
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.
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.
喉癌在全球范围内并不罕见。我们开展这项研究以全面比较在全喉切除术（初次或挽救性手术）中使用吻合器与传统缝合的结果。
这是一项在我们的三级医疗机构于2015年至2022年进行的回顾性研究，纳入了被诊断为喉癌并接受初次或挽救性全喉切除术的患者。我们将患者分为4组：初次或挽救性全喉切除术，分别采用吻合器或手工缝合进行闭合。报告的结果包括：手术时间、住院时间、开始经口进食时间、咽皮肤瘘发生率、手术切缘阳性率以及手术部位感染情况。排除患有多种合并症以及需要皮瓣进行咽闭合的患者。
我们的研究共纳入91例患者。在初次全喉切除术中，传统缝合组的咽皮肤瘘发生率为19%，而吻合器组为6.7%；在挽救性手术中，吻合器组为12.5%，传统缝合组为25%。在初次全喉切除术中，吻合器组的住院时间为6±1.5天，传统缝合组为11.4±2.9天。在挽救性全喉切除术中，吻合器组为8.8±1.3天，传统缝合组为13.1±1.8天。在平均手术时间、开始经口进食时间和住院时间方面，使用吻合器具有显著优势。
在全喉切除术中使用吻合器是一种简单、快速且有效的技术，与手工缝合相比，能实现无张力的水密闭合、更好的止血效果以及更少的手术野污染。
