الفهرس 
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Abstract
Pharyngocutaneous fistula is the most common surgical complication after total laryngectomy. It is associated to a higher incidence of morbidity, hospitalisation and costs.
Although a stapler has only recently been used for pharynx closure, it has been widely applied in gastrointestinal surgeries. The use of a stapler during the resection of Zenker diverticula was described for the first time in 1969.
The use of a stapler for pharyngeal closure after total laryngectomy seems to be adequate for endolaryngeal tumours. It was first described in 1973. The closure is watertight and the contamination of the surgical field by secretions from mouth and pharynx decreases. As a result, the occurrence of pharyngocutaneous fistula is minimised, even in recurrent cases after radiation therapy. Furthermore, pharynx closure is faster.
In spite of being a relatively simple technique with potential advantages, there is a lack of comparative studies available in the literature.
The aim of this study was to evaluate the use of stapling for primary closure of the pharynx after total laryngectomy.
This study was conducted on patients undergoing total laryngectomy by staff of Otorhinolaryngology and Head& Neck surgery department, faculty of medicine, Alexandria University, Egypt, at Alexandria Main University Hospital and its related hospitals.
The patients classified into two groups as follows:
group I: Closure of the pharynx using stapler (15 patients).
group II: Closure of the pharynx using conventional inverting suturing (connell) in straight line (15 patients).
The data was collected, tabulated and analyzed as follows:
Our results summarized that:
- Regarding demographic data, the age of the patients in group I ranged from 48-67 years, with a mean 56.2±7.09 years, while in group II the age of patients ranged from 41-69 years, with a mean of 55.9±7.82 years, on comparing the two groups regarding age it was found that there was no significant difference. Regarding sex, in group I the male represent 93.3% of the cases while only one case was female, in group II there was 13 cases male and two cases females, there was no significant difference between the two groups regarding sex. Also, there was no significant difference between the two groups regarding smoking.
- Regarding clinical data, 60.0% of the patients in group I had diabetes mellitus, while 46.7% of the patients in group II had diabetes mellitus, there was no significant difference between the two groups regarding incidence of DM. In group I, 33.3% of the patients had hypertension, while in group II 40.0% of the patients had hypertension, there was no significant difference between the two groups regarding the incidence of hypertension. All patients in the two groups had NG insertion.
- Regarding hospital stay, in group the hospital stay was ranged from 10-15 days with a mean of 11.93±1.39 day, while in group II the hospital stay was ranged from 14-16 days with a mean of 14.73±0.70 days, there was a highly significant increase in hospital stay in group II more than group I.
- Regarding start of oral feeding, there was a significant increase in the duration to start of oral feeding in group II more than group I.
- Regarding post-operative complications, the incidence of different complication which include fever, infection, hematoma and fistula was matched in the two groups without significant difference.