Bacterial colonization of Montgomery salivary bypass tubes after hypopharyngeal reconstruction in head and neck cancer patients

Stefan Grasl,Boban M Erovic,Bernhard Parschalk,Georg Haymerle,Stefan Janik,Matthaeus Christoph Grasl

doi:10.1007/s00405-019-05768-z

Stefan Grasl, Boban M Erovic + Show 4 more

Open Access

https://doi.org/10.1007/s00405-019-05768-z

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Abstract

BackgroundHypopharyngeal reconstruction after salvage pharyngolaryngectomy results in high postoperative morbidity. The use of salivary bypass tubes can reduce pharyngocutaneous fistula (PCF) formation. The influence of bacterial colonization has not been described in literature.MethodsBacterial swipes from 26 consecutive patients reconstructed after laryngopharyngectomy in combination with Montgomery salivary bypass tubes (MSBT) were analyzed in regards to PCF formation.ResultsPCF occurred in 2 untreated primary and in 9 salvage laryngopharyngectomies, respectively. Bacterial colonization showed high rates of gram-negative pathogens and drug resistance to standard Ampicillin treatment. Type of bacteria was not associated with fistula formation. Antibiotic resistance was found in 6 out 11 patients (54%) with PCF.ConclusionsWe identified high rates of antibiotic-resistant Gram-negative pathogens on MSBT. Although not statistically significant, PCF were found more frequently in drug-resistant patients. Bacterial colonization of hypopharyngeal reconstructions should therefore be taken into account for perioperative prophylaxis.

Highlights

Hypopharyngeal reconstruction after extensive oncologic resections of the larynx and hypopharynx depict a vast impact on postoperative morbidity
Patients were reconstructed with radial forearm free flap (RFFF), serratus anterior free flap (SAFF) or pectoralis major myocutaneous flap (PMMF) or a combination of two flaps in case of circumferential defects
Even though the prophylactic use of Montgomery salivary bypass tubes (MSBT) with fasciocutaneous flaps has been recommended to prevent severe complications, the rate of fistulas remains high in pretreated head and neck cancer patients [15]

Summary

Introduction

Hypopharyngeal reconstruction after extensive oncologic resections of the larynx and hypopharynx depict a vast impact on postoperative morbidity. In patients with preoperative radiotherapy the fistula rate remains at 10–50% [1,2,3]. Hypopharyngeal reconstruction after salvage pharyngolaryngectomy results in high postoperative morbidity. The use of salivary bypass tubes can reduce pharyngocutaneous fistula (PCF) formation. The influence of bacterial colonization has not been described in literature. Methods Bacterial swipes from 26 consecutive patients reconstructed after laryngopharyngectomy in combination with Montgomery salivary bypass tubes (MSBT) were analyzed in regards to PCF formation. Bacterial colonization showed high rates of gram-negative pathogens and drug resistance to standard Ampicillin treatment. Antibiotic resistance was found in 6 out 11 patients (54%) with PCF. Conclusions We identified high rates of antibiotic-resistant Gram-negative pathogens on MSBT. PCF were found more frequently in drug-resistant patients. Bacterial colonization of hypopharyngeal reconstructions should be taken into account for perioperative prophylaxis

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