SynthesisEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Stapler versus manual closure for pharyngeal repair after total laryngectomy: a systematic review and meta-analysis.
Synthesis in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Pharyngeal and Cervical Reconstruction and Fistula Management Following Total Laryngectomy: Contemporary Strategies and Evidence.Life (Basel, Switzerland) · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPharyngeal closure is a critical step in total laryngectomy influencing postoperative recovery. While manual suturing is traditional, stapler-assisted closure offers potential advantages. This study provides an updated meta-analysis comparing stapler versus manual closure, stratifying by surgical indication, laryngectomy type and stapler technique. METHODOLOGY: Following PRISMA guidelines, a systematic search of four databases, up to November 2025, was conducted. Randomized controlled trials (RCTs) and observational studies comparing stapler versus manual closure in total laryngectomy were included. The primary outcome was pharyngocutaneous fistula (PCF) incidence. Secondary outcomes mainly included operative time and hospital stay. Risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.
resultsTwenty studies (4 RCTs, 16 observational) involving 1,545 patients were included. Stapler closure was associated with a significantly lower risk of PCF (RR = 0.54, 95% CI [0.38, 0.76], p < 0.001), shorter operative time (MD = -52.60, 95% CI [-74.33, -30.86], p < 0.001), and reduced hospital stay (MD = -3.62, 95% CI [-5.49, -1.76], p < 0.001). Subgroup analysis demonstrated a significant PCF reduction in primary laryngectomy (RR = 0.40, 95% CI [0.24, 0.69], p > 0.001), but this benefit was not statistically significant in salvage laryngectomy alone. Closed and semi-closed stapler techniques showed the most significant protective effects.
conclusionStapler-assisted pharyngeal closure significantly reduces PCF incidence, operative time, and hospitalization compared to manual suturing in primary laryngectomy. While efficient, its superiority in preventing PCF in high-risk salvage settings is not established, warranting careful patient selection.
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