Do Salivary Bypass Tubes Reduce the Risk of Pharyngocutaneous Fistula after Laryngopharyngectomy—A Systematic Review and Meta-Analysis

Abstract

To evaluate the effect of salivary bypass tube (SBT) usage on the occurrence of pharyngocutaneous fistula (PCF) in patients after a laryngopharyngectomy, a total of 20 studies, published between 1988 and 2021, were identified including 2946 patients. We performed a meta-analysis assessing the risk of PCF occurrence in patients after SBT application compared to those without. PCF occurred in 26.8% of cases (669/2496) and SBT was applied in 33.0% of patients (820/2483). There was an overall trend towards lower PCF rates when using SBTs (22.2% vs. 35.3%; p = 0.057). We further selected five studies, comprising 580 patients who underwent laryngopharyngectomies, for meta-analysis showing that application of SBT reduced the risk of PCF formation (OR 0.46; 95% CI 0.18–1.18; p = 0.11). The meta-analysis demonstrates a beneficial effect of SBT insertion on PCF formation in patients after laryngopharyngectomy.

Radial forearm free flap and a freka-trelumina tube for management of a refractory pharyngocutaneous fistula: A case report

“…Salivary bypass tubes and low-pressure drainage suctions have recently been reported to reduce the risk of PCF after laryngectomy. 8,9 However, the placement of both of these, in addition to a single-cavity nasogastric tube, was not a viable option for our patient. The triple-lumen Freka-Trelumina nasojejunal tube has normally been used in pancreatic disease patients.…”

Neopharyngeal Stricture following Laryngectomy

“…When these were excluded, statistical significance was reached in regard to a lower risk of PCF formation with the use of SBT. 69 SBTs have been employed in all forms of reconstruction and defect types; however, analysis on data regarding direct comparisons among different reconstruction techniques is lacking. Although not reaching statistical significance, SBTs have also been shown to produce low stricture rates when used in conjunction with PMMC, RFFF, and ALTFF.…”

“…When these were excluded, statistical significance was reached in regard to a lower risk of PCF formation with the use of SBT. 69…”

“…67,68 A meta-analysis of SBT use in laryngectomy found that time to removal of SBT ranged from 10 to 60 days, with a mean of 21.8 days. 69 There was marked heterogeneity in the studies included in analysis, especially when those where less than 20% of the patients were given SBT during surgery were included. When these were excluded, statistical significance was reached in regard to a lower risk of PCF formation with the use of SBT.…”

Institutional experience with total pharyngectomy reconstruction: Exploring the role of the salivary bypass tube

“…Others, however, report a connection to increased complication rates. [8][9][10][11] Regardless, the data supporting SBT use in pharyngeal reconstruction is mostly low-level and derived from series involving heterogeneous patient populations.…”