Pharyngocutaneous fistula complicating laryngectomy: can metronidazole help?

Aim: To evaluate the use of metronidazole as a prophylactic agent against pharyngocutaneous fistula (PCF) formation.

Patients And Methods: Seventy patients who underwent total laryngectomy between 2000 and 2008 in our department were divided into two groups. The first group (M+ group) was placed on a 10-day metronidazole regimen (2 days prior to surgery and 7 days following). The second group (M- group) received only regular preoperative chemoprophylaxis.

Results: In total, 17 (24.3%) incidents of PCF were reported, 3 of which were in the M+ group, with the remainder in the M- group. A statistically significant reduction in the PCF rate was noted in favor of metronidazole in the overall population (p = 0.005), as well as in the patient group that had received radiotherapy prior to surgery (p = 0.03).

Conclusion: Metronidazole administered for a total of 10 days pre- and postoperatively seems to lower the incidence rate of PCF formation.