Work

Early Oral Gastrografin Followed by Immediate CT for Precise Leak Localization and Surgical Planning After Total Laryngectomy

Year: 2026

Type: article

Abstract: ABSTRACT Purpose Pharyngocutaneous fistula (PCF) is the most common and clinically significant complication following total laryngectomy, often leading to delayed recovery and increased morbidity. Accurate and early detection of pharyngeal leak is critical; however, conventional imaging modalities such as contrast swallow studies and computed tomography (CT) have limitations in precise anatomical localization. Materials and Methods This retrospective cohort study included 117 patients who underwent total laryngectomy between January 2020 and December 2025. Patients were divided into two groups according to the postoperative imaging protocol: Gastrografin swallow followed by immediate CT (Gastrografin–CT group, n = 22) and conventional imaging ( n = 95). Leak localization was assessed using a four‐point ordinal scale, and surgically actionable localization was defined as a score ≥ 2. Clinical outcomes and impact on management were also evaluated. Results The Gastrografin–CT protocol demonstrated significantly improved leak localization compared with conventional imaging (mean localization score: 3.00 ± 0.00 vs. 1.62 ± 0.83, p = 0.01). Surgically actionable localization was achieved in all patients in the Gastrografin–CT group compared with 51.2% in the conventional group ( p = 0.03). Leaks were identified on initial imaging in 100% of patients in the Gastrografin–CT group versus 82.9% in the conventional group. Although clinical outcomes, including time to oral feeding, complication rates, and hospital stay, did not significantly differ, the Gastrografin–CT protocol provided more precise anatomical delineation, facilitating targeted surgical planning. Conclusion Performing CT immediately after an oral Gastrografin swallow significantly improves anatomical localization of pharyngeal leaks following total laryngectomy. By integrating leak detection and anatomical delineation in a single imaging session, this protocol enhances surgical decision‐making and may serve as a practical adjunct for postoperative evaluation and management of PCF. Level of Evidence 3.

Source: Laryngoscope Investigative Otolaryngology

DOI: 10.1002/lio2.70606

Authors: Seung Jo Jeong, Minsu Kwon, Yoon Se Lee, Young Ho Jung, Seung‐Ho Choi, Seung Hoon Han

Institutions: Asan Medical Center, University of Ulsan

Language: English

Topic: Head and Neck Cancer Studies

Subfield: Otorhinolaryngology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,900