Efficiency of Endoluminal Vacuum-Assisted Closure Therapy for Pharyngocutaneous Fistula

The aim of this study was to evaluate the efficacy of endoluminal vacuum-assisted closure (EndoVAC) therapy for patients with pharyngocutaneous fistula by placing a sponge in the intraluminal pharyngeal space using a transoral approach. The authors retrospectively enrolled 12 patients with pharyngocutaneous fistula, who were treated with EndoVAC therapy from 2023 to 2024. Of the 12 patients, 10 patients had pharyngocutaneous fistula after surgery for head and neck malignancy, 1 patient had a leak in the pharyngoesophageal junction caused by bougienage, and 1 patient had a pharyngocutaneous fistula associated with antiphospholipid syndrome. The average time for fistula detection after surgery was 7.27±1.68 days. Among the 12 patients, 5 patients were treated with EndoVAC alone, and 7 patients were treated with both EndoVAC and external negative pressure wound therapy (NPWT). The average number, duration, and an average change interval of EndoVAC procedures among all 12 patients was 2.91±0.41, 20.08±3.60 days, 6.87±0.39 days, respectively. All 12 cases of pharyngocutaneous fistula were successfully closed without additional reconstructive flap surgery. The mean time to fistula healing was 36.25±5.89 days. When the 10 patients who developed postoperative pharyngocutaneous fistula were divided into 2 groups based on whether preventive EndoVAC was performed or not, the time for improvement of the 5 patients who underwent preventive EndoVAC was 26.2±3.81 days. Whereas for 5 patients who did not, it was 43±10.33 days. EndoVAC is considered a straightforward and effective treatment for pharyngocutaneous fistula.