Salivary bypass tube in total laryngectomy: Systematic review and meta‐analysis

Abstract

The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of postoperative pharyngocutaneous fistula (PCF) and pharyngeal stenosis (PS). This study was conducted in conformity with the PRISMA statement. 1960 patients with a median age of 62.0 years were included. A SBT was placed in 980 (50%) patients (SBT group). The cumulative PCF incidence in the SBT group was 15.8% (95% CI: 9.3–23.6). The measured pooled OR comparing PCF incidence in patients with SBT compared to those without was 0.40 (95% CI: 0.24–0.65). The pooled PS incidence in the SBT group was 12.3% (95% CI: 5.4–21.6). The measured pooled OR comparing PS incidence in patients with SBT compared to those without was 0.43 (95% CI: 0.24–0.65). PCF and PS could be prevented by the intra‐operative placement of a SBT.

Videofluoroscopic swallowing study to detect pharyngeal leak after total (pharyngo‐) laryngectomy: Retrospective assessment of a single‐institution protocol

“…6,8 On the other hand, the use of flaps, salivary bypass tubes and the protocol for oral feeding resumption have been found to reduce the rate of fistula. 5,9,10 Another option to reduce the rate of PCF may be the timely detection and treatment of PL, before its evolution into a PCF. 11,12 Avoiding this evolution is crucial since a PCF leaking into the stoma often requires the wearing of a cuffed tracheostomy tube, more complex dressings, prolonged hospital stay and/or surgical revision.…”

“…Several meta‐analyses highlighted that age, smoking, chronic obstructive pulmonary disease, coronary artery disease, T‐stage, previous radiotherapy, low preoperative albumin, low preoperative hemoglobin, tumor site and positive mucosal margins were risk factors for PCF 6,8 . On the other hand, the use of flaps, salivary bypass tubes and the protocol for oral feeding resumption have been found to reduce the rate of fistula 5,9,10 . Another option to reduce the rate of PCF may be the timely detection and treatment of PL, before its evolution into a PCF 11,12 .…”

Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula

“…Use of salivary bypass tubes to prevent PCF was described by Montgomery as far back as 1978 35 . Placement of a silicone salivary bypass tube in the pharynx and esophagus could help saliva to flow unopposed directly into the esophagus, preventing pooling at the level of the sutures placed during surgery 36,37 . However, clinical application of salivary bypass tubes is limited because of the need for repeat surgery and their potentially lethal complications 38–40 .…”

“…35 Placement of a silicone salivary bypass tube in the pharynx and esophagus could help saliva to flow unopposed directly into the esophagus, preventing pooling at the level of the sutures placed during surgery. 36,37 However, clinical application of salivary bypass tubes is limited because of the need for repeat surgery and their potentially lethal complications. [38][39][40] Marchese et al reported that intraparotid injection of botulinum neurotoxin A could substantially contribute to closure of PCF by significantly decreasing the flow of saliva.…”

Lacunae in meta-analyses of Pharyngocutaneous fistula after laryngectomy: A bibliometric study

“…Six meta-analyses (25%) have been published in the Head Neck Journal (affiliated with the International Federation of Head and Neck Oncologic Societies) 5,[7][8][9][10][11] . Three were published in the Laryngoscope journal (affiliated with the American Triological Society) 13,14,22 .…”