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

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.