Incidence Of Fistula In Patients Research Articles

Análisis de factores predictivos en la aparición de fístulas faringocutáneas poslaringectomía total

Background: Pharyngocutaneous fistula is the most common complication after total laryngectomy. The factors associated with its development have been studied by several authors without conclusive results. Objective: To evaluate the causes for the development of PCF and to describe the risk factors associated with PCF in the population studied. Material and methods: We conducted a retrospective and observational study with statistical analysis of the variables. A total of 55 patients undergoing initial or salvage total laryngectomy from January 2000 to December 2019 were included. Male-to-female ratio was 48/7. Mean age was 61.3 years. The pathological diagnosis was epidermoid carcinoma in 96.36% of the cases. Statistical analysis: (chi square test and Mann-Whitney test) of the variables related with the development of pharyngocutaneous fistula. Results: The incidence of fistula in patients with laryngectomy was 20%. Spontaneous closure occurred in 72.73% and 3 patients (27.27%) required the use of flaps. In patients with fistula, 63.64% had previous radiotherapy. In these patients, the use of nasogastric tube feeding lasted > 15 days. Mean length of hospital stay in patients with fistula with 23 days. Conclusion: In our environment, previous radiotherapy was the most significant factor associated with the development of fistula. In these patients, fistula took longer to close and required more complex reconstructions in some cases.

Comparative Study of Modifying Meatal Advancement Glandular with Release Chordi versus Snodgrass Surgical Methods Regarding the Repair of Distal Hypospadias.

Hypospadias is one of the most common congenital anomalies of the external genitalia of boys. No single technique can be recommended for the repair of hypospadias in its various forms. We aimed to compare modify meatal advancement glandular with release chordi versus Snodgrass surgical methods in the repair of distal hypospadias. In this study, conducted from Apr 2018 to the end of Sep 2020, all boys who underwent one of the two methods of Snodgrass and modify meatal advancement glanuplasty with release chordi in Imam Khomeini and Abuzar Hospitals of Ahvaz, Southern Iran, were enrolled. Forty-five patients underwent Snodgrass (group S) and 55 patients underwent modified meatal advancement glandular with release chordi (group M). The mean age of patients and duration of surgical wound healing in the two groups did not differ significantly. There was no significant difference between the two groups in terms of complications, including Bleeding, Hematoma, Meatus stricture, Wound infection, detachment of the wound edge, chordi after surgery, Balanitis and Urethral stricture but the incidence of fistula in patients undergoing Snodgrass repair was significantly higher than the group modify meatal advancement glandular with release chordi (P<0.05). The method of modify meatal advancement glandular with release chordi compared to Snodgrass method is associated with fewer complications due to surgery, although further studies are recommended.

Incidence and risk factors of pharyngocutaneus fistula formation after total laryngectomy. Review

Introduction and objective: The pharyngocutaneous fistula is a troublesome complication after total laryngectomy, increasing morbidity and mortality. We aimed to determine the incidence of pharyngocutaneus fistula after total laryngectomy and to define the possible predictors for pharyngocutaneus fistula formation. Method: We conducted a review of 31 articles with a total of 1100 patients, to evaluate the incidence of fistula in patients with total laryngectomy and risks factors involved. Results: The overall incidence of pharyngocutaneus fistula is 22,3%, and ranges from 3 to 65%. The review revealed that prior radiation treatment was the most common antecedent, following this associated comorbidity, hypoalbuminemia, anemia, and history of tracheotomy prior to laryngectomy. Discussion: Among the series studied, there is significant heterogeneity in the results, because although irradiated patients have a greater number of pharyngostomas, in some studies no relationship was found, which could explain the association with other risk factors. Conclusions: The incidence of pharyngocutaneus fistula is very variable and there are a large number of risk factors involved, the most frequent is radiotherapy associated or not with chemotherapy.

Introduction of the displaced and crossover type of mattress suture for hard palate closure

e he incidence of oronasal fistula in patients with cleft palate ho have had the anterior region of the hard palate closed s about 35%.1 Various protocols and techniques have been eveloped with the aim of achieving a safe, tension-free cloure of the oral and nasal layers so that possible dehiscence nd the formation of fistula are minimised.1,2 Three types f mattress sutures, vertical, horizontal, and U-shaped,3 are laced under tension and commonly used for the tight cloure of skin and mucosa.4,5 An additional advantage is the version of the wound edges that causes less scarring after ealing. Two different types of mattress sutures have been introuced for reconstruction of the cleft in the hard palate in both rimary palatal surgery and closure of oronasal fistulas. The isplaced mattresss suture (Figs. 1–3) is suitable for use in he highly-arched palate, particularly in the anterior palatal rea. The crossover mattress suture (Figs. 1–3) may be used to pproximate the released oral flaps and to anchor the sutured asal flaps tightly in two directions. Where a highly-arched r deeply-grooved palate is involved, it is difficult to rotate he non-specialised needle to exit on the opposite side, close o the incisional edge, and the needle often emerges some istance from the edge of the incision. This usually results in loose, displaced suture and knot. In contrast, the displaced attress approach allows the suture to be knotted close to the dge of the incision, which also everts the mucosa against

Pharyngocutaneous fistula as a complication of total laryngectomy: Review of the literature and analysis of case records

Pharyngocutaneous fistula is the most common complication of total laryngectomy. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, where indicated. To identify factors predisposing to the development of pharyngocutaneous fistula, we reviewed the postoperative courses of 293 patients who underwent total laryngectomy at our clinic. General factors taken into account were concurrent diseases such as diabetes, liver diseases, or chronic anemia; local factors included radiotherapy before and after surgery, preoperative tracheostomy, type of cervical lymph node removal, and method of pharyngeal closure. We then compared our data with those reported in the literature by other authors. Last, we applied the Fisher exact test to a correlation we found between the higher incidence of fistula in patients with diabetes, liver diseases, or anemia. The local factor that turned out to be statistically most significant for the development of fistula was preoperative radiotherapy. (Otolaryngol Head Neck Surg 2000;123:587-92.)