Title: Use of fibrin sealant as an adjunct in primary pharyngeal closure, a multi-centre experience

Background
Pharyngocutaneous fistula is a common complication following laryngectomy. Fibrin sealant, such as Tisseel, has been explored as an adjunct in reducing fistula formation. This study evaluates its effectiveness in decreasing fistula rates when used in primary closure.
Methods
A retrospective review of 84 laryngectomy cases from 2015 to 2024 by a single surgeon from 3 centres was conducted. Tisseel fibrin sealant was used as an adjunct to primary closure. The incidence of fistula formation, including primary and salvage cases, was analysed.
Results
A total of 9 cases (10%) developed pharyngocutaneous fistulas. Of these, 1% were primary fistulas, and 10% occurred in salvage procedures.
Conclusion
Pharyngocutaneous fistula rates in laryngectomy patients post-radiation and chemoradiotherapy have been reported as 23% and 34%, respectively. This study demonstrates a low primary fistula rate of 1%. The use of Tisseel as an adjunct to scrupulous closure techniques offers promising results in reducing fistula formation, particularly in high-risk patients.