Changing Paradigm for Ryle's Tube Removal after Total Laryngectomy

Abstract

Changing Paradigm for Ryle’s Tube Removal after Total Laryngectomy Objectives: The time to begin oral feeding after total laryngectomy remains a subject of debate among Head and Neck Surgeons. With the prevailing assumption that early oral feeding may cause the development of pharyngo-cutaneous fistula (PCF) many surgeons initiate oral feeding after 7-10 days. The present study is aimed to demonstrate the feasibility and safety of early oral feeding after total laryngectomy. Study design: A retrospective comparative chart review of all total laryngectomies done during 2008 -2013 was included in the study. Materials and Methods: A total of 50 total laryngectomies done in Post Graduate Institute of Medical Education and Research, Chandigarh during 2008-2013 were divided into two groups. Group A in whom oral feeds were started on 4th post operative day and Group B in whom oral feeds were started on 10th post operative day. The incidences of pharyngocutaneous fistula in both groups have been compared. Results: The incidence of pharyngocutaneous fistula was 7.14% in group A and 9% in group B. the difference being statistically insignificant (p>0.05). Conclusion: Evaluation of fistula incidence in our series indicates that early initiation of oral feeding does not contribute to fistula formation rather the advantage of relatively shortened hospital stay and helps eliminate psychological and traumatic side effects of tube feeding.