Barbed versus polyglactin sutures for pharyngeal closure after total laryngectomy: A pilot study.

OBJECTIVES

To compare the incidence of pharyngocutaneous fistula and pharyngeal closure time between barbed and conventional polyglactin sutures after total laryngectomy.

METHODS

A single-blinded, randomized clinical trial was conducted from February 2023 to October 2024 at a tertiary academic center. Participants included adults with advanced laryngeal or hypopharyngeal carcinoma undergoing primary total laryngectomy with primary pharyngeal closure. Salvage laryngectomies and patients requiring patch pharyngoplasty were excluded. Patients were randomized 1:1 to pharyngeal closure with either a continuous 3-0 polyglycolic acid barbed suture or a continuous 3-0 polyglactin (Vicryl) suture. The primary outcome was the incidence of pharyngocutaneous fistula. The secondary outcome was pharyngeal closure time.

RESULTS

Sixty patients were randomized (median age, 59.7 years; 95% men). Pharyngocutaneous fistula occurred in 5 of 30 patients (16.7%) in the Vicryl group and in none of the 30 patients in the barbed suture group; this difference did not reach statistical significance. Median pharyngeal closure time was shorter in the barbed suture group (15 min) compared with the Vicryl group (25 min).

CONCLUSION

In this randomised pilot clinical trial, the use of barbed sutures was associated with shorter pharyngeal closure time and a numerically lower fistula rate. These findings suggest potential technical advantages of barbed sutures, although larger, adequately powered trials are required to confirm an effect on pharyngocutaneous fistula incidence.

TRIAL REGISTRATION: Clinical Trials Registry-India Identifier: CTRI/2023/06/054351.

LEVEL OF EVIDENCE: Level 2.