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Acta Medica Medianae
Vol. 49, No 4, December, 2010

UDK 61
ISSN 0365-4478(Printed version)
ISSN 1821-2794(Online)


Correspondence to:

Predrag Spirić

ENT Clinic, Clinic Center Banja Luka, Bosnia and Herzegovina

12 beba bb, 78000 Banja Luka

Bosnia and Herzegovina

E-mail sanjapre@inecco.net








Original article
UDC:  616.22-089.85





Predrag Spirić1, Sanja Spirić2 and Milan Stanković2



ENT Clinic, Clinic Center Banja Luka, Bosnia and Herzegovina1

ENT Clinic, Clinic Center Niš, Serbia2


Surgical technique of total laryngectomy is well presented in many surgical textbooks. Essentially, it has remained the same since Gluck an Soerensen in 1922 described all its details. Generally, it stresses the U shape skin incision with releasing laryngeal structures and removing larynx from up to down. Further, pharyngeal reconstruction is performed with different kinds of sutures in two or more layers and is finished with skin suture and suction drainage. One of worst complications following this surgery is pharyngocutaneous fistula (PF). Modifications proposed in this this article suggests vertical skin incision with larynx removal from below upwards. In pharyngeal reconstruction we used the running locked suture in submucosal plan with „tobacco sac“ at the end on the tongue base instead of traditional T shaped suture. Suction drains were not used.   

The aim of study was to present the modified surgical technique of total laryingectomy and its impact on hospital stay duration and  pharyngocutanous fistula formation.In this randomized study we analyzed 49 patients operated with modified surgical technique compared to 49 patient operated with traditional surgical technique of total laryngectomy. The modified technique of total laryngectomy was presented. Using modified technique we managed to decrease the PF percentage from previous 20,41% to acceptable 8,16%(p=0,0334). Also, the average hospital stay was shortened from 14,96 to 10,63 days (t=-2.9850; p=0.0358).

The modified technique of total laryngectomy is safe, short and efficient surgical intervention which decreases the number of pharyngocutaneos fistulas and shortens the hospital stay. Acta Medica Medianae 2010;49(4):39-42.


Key words: laryngeal neoplasms, laryngectomy, cutaneous fistula