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Routine use of salivary bypass tubes in laryngectomy patients: systematic review

  • Y Kamhieh (a1), H Fox (a2), E Hallett (a3) and S Berry (a4)

Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to reduce the incidence of fistulae and neopharyngeal strictures.


Following a systematic search of Embase, Medline and Cochrane databases (1946 – current), included articles were assessed for bias according to the Cochrane Handbook for Systematic Reviews of Interventions.


Three case–control trials showed reduced pharyngocutaneous fistula rates with the use of salivary bypass tubes; six case series reported widely varied fistula rates. With regards to stricture rates, the largest case–control trial found no improvement with salivary bypass tube use. No fatal adverse events were observed among the 204 patients who received a salivary bypass tube.


Low-level evidence suggests salivary bypass tubes may reduce the incidence of fistula in high-risk patient groups. A robust randomised controlled trial, or large, multicentre cohort studies, are needed to further examine this intervention.

Corresponding author
Address for correspondence: Ms Yasmine Kamhieh, ENT Department, Morriston Hospital, Swansea SA6 6NL, Wales, UK E-mail:
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Presented orally at the American Head & Neck Society Meeting, 16–20 July 2016, Seattle, Washington, USA, and as a poster at the Wales Otorhinolaryngology Association Meeting, 7 October 2016, Saundersfoot, Wales, UK.

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
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