Early Oral Gastrografin Followed by Immediate CT for Precise Leak Localization and Surgical Planning After Total Laryngectomy.
- 1Department of Otorhinolaryngology-Head and Neck Surgery Asan Medical Center, University of Ulsan College of Medicine Seoul Korea.
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.
Related
- Comparison of surgical outcomes, safety, and cosmetic satisfaction between immediate implant-based and transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction following total mastectomy: a retrospective cohort study
- Closure without epiglottoplasty or tracheotomy after reconstructive frontal anterior laryngectomy
- Axillary metastases following total laryngectomy: an under-recognised pathway
- Chest Wall Tuberculosis Followed by Tuberculous Pleuritis
- Delayed giant thoracic pseudomeningocele presenting as enlarging painless paraspinal swelling followed by postural dizziness: a case report
BibTeX
@article{jeong2026early,
title = {{Early Oral Gastrografin Followed by Immediate CT for Precise Leak Localization and Surgical Planning After Total Laryngectomy.}},
author = {Seung Jo Jeong and Minsu Kwon and Yoon Se Lee and Young Ho Jung and Seung-Ho Choi and Seung Hoon Han},
journal = {Laryngoscope investigative otolaryngology},
year = {2026},
month = oct,
doi = {10.1002/lio2.70606},
url = {https://europepmc.org/article/MED/42898996},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Early Oral Gastrografin Followed by Immediate CT for Precise Leak Localization and Surgical Planning After Total Laryngectomy.
AU - Seung Jo Jeong
AU - Minsu Kwon
AU - Yoon Se Lee
AU - Young Ho Jung
AU - Seung-Ho Choi
AU - Seung Hoon Han
PY - 2026
DA - 2026/10/19
JO - Laryngoscope investigative otolaryngology
DO - 10.1002/lio2.70606
UR - https://europepmc.org/article/MED/42898996
AB - 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.
SN - 2378-8038
ER -