Surgical Drain Placement Technique and Its Effects Following Total Laryngectomy
Abstract
Objective: We aimed to determine whether securing Jackson-Pratt (JP) drains with suture both internally and externally (IE) vs. externally only (EO) after total laryngectomy affects drain migration and incidence or rate of postoperative complications.
Study Design: Retrospective chart review.
Setting: Single institution urban tertiary care center.
Methods: Fifty-three patients who underwent total laryngectomy were reviewed retrospectively and categorized as IE or EO. Post-operative esophagograms were reviewed by 12 non-affiliated Otolaryngologists. Drain displacement, post-operative complication rates and time to detection of complication were compared.
Results: Fewer radiographs (20.7%) were designated as "displaced" in the IE group compared to the EO group (30.4%) (p = 0.05). There was no difference in complication rates or median time to detect salivary leaks between the two groups.
Conclusion: The utilization of an internal suture technique to secure surgical drains following total laryngectomy was associated with a decreased rate of drain migration. However, drain migration did not appear to affect complication rates or timing of detection of a salivary leak.
References
Schwarts SR, Yueh B, Maynard C, et al. Predictors of wound complications after laryngectomy: a study of over 2000 patients. Otolaryngol Head Neck Surg . 2004;131:61–68.
Samraj K, Gurusamy KS. Wound drains following thyroid surgery. Cochrane Database Syst Rev. 2007;Oct 17(4):CD006099.
Bastian RW, Park AH. Suction drain management of salivary fistulas. Laryngoscope. 1995;105(12 Pt 1):1337-1341.
Heskin L, Cahill V, Filobbos G, Regan P, O'Sullivan ST, Bryan K. A new adaptation for a secure surgical drain placement and a comparison with four common drain fixation methods. Ann R Coll Surg Engl. 2019;101(1):60-68.
Anehosur V, Ghosh R, Joshi A, Jayade B, Kumar N. Drain Tags: A Reliable Method of Securing Drains in the Neck. Indian J Surg. 2018;80(1):100-102.
Jayaraj SM, Ghufoor K, Patel KS. Surgical technique. Securing of surgical drains in the neck. Ann R Coll Surg Engl. 1998;80(6):438.
Kwon D, Genden EM, de Bree R, et al. Overcoming wound complications in head and neck salvage surgery. Auris Nasus Larynx. 2018;45(6):1135-1142.
Dedivitis RA, Aires FT, Cernea CR, Brandão LG. Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head Neck. 2015;37(11):1691-1697.
Galli J, De Corso E, Volante M, et al. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Otolaryngol Head Neck Surg. 2005;133(5):689–694.
White HN, Golden B, Sweeny L, Carroll WR, Magnuson JS, Rosenthal EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope. 2012;122(8):1796-1799.
Timmermans AJ, Lansaat L, Theunissent EA, et al. Predictive factors for pharyngocutaneous fistualization after total laryngectomy. Ann Otol Rhinol Laryngol . 2014;123:153–161.
Avci H, Karabulut B. Is It Important Which Suturing Technique Used for Pharyngeal Mucosal Closure in Total Laryngectomy? Modified Continuous Connell Suture May Decrease Pharyngocutaneous Fistula. Ear Nose Throat J. 2020;99(10):664-670.
Deniz M, Ciftci Z, Gultekin E. Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy. Surg Res Pract. 2015;2015:363640.
Park J, Chang C, Kwon D. Use of fibrin adhesive for preventing pharyngocutaneous fistula in total laryngectomy. Am J Otolaryngol. 2020;41(6):102674.
Stanisce L, Lai M, Ahmad N, et al. Outcomes Associated with Fibrin Sealant Use in Lateral Neck Dissections. OTO Open. 2020;4(4):2473974X20981021.
