{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:44:24Z","timestamp":1787863464885,"version":"build-2784847793"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Dublin, Trinity College"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pharyngeal 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty studies (4 RCTs, 16 observational) involving 1,545 patients were included. Stapler closure was associated with a significantly lower risk of PCF (RR\u2009=\u20090.54, 95% CI [0.38, 0.76],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), shorter operative time (MD = -52.60, 95% CI [-74.33, -30.86],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and reduced hospital stay (MD = -3.62, 95% CI [-5.49, -1.76],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Subgroup analysis demonstrated a significant PCF reduction in primary laryngectomy (RR\u2009=\u20090.40, 95% CI [0.24, 0.69],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.001), but this benefit was not statistically significant in salvage laryngectomy alone. Closed and semi-closed stapler techniques showed the most significant protective effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Stapler-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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-026-10129-8","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T14:12:35Z","timestamp":1773065555000},"page":"4131-4153","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Stapler versus manual closure for pharyngeal repair after total laryngectomy: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"283","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4113-9258","authenticated-orcid":false,"given":"Noof","family":"Albannai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munawer","family":"Alsaeed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqoub Yousef","family":"Alenezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bander M.","family":"Alshammari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawaf","family":"Almotairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noora","family":"Albuainain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Retaj","family":"Alawadhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah M.","family":"Alharran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mishal","family":"Almutairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"10129_CR1","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1007\/s11912-024-01516-7","volume":"26","author":"E Crosetti","year":"2024","unstructured":"Crosetti E, Fantini M, Bertotto I, Bertolin A, Arrigoni G, Lorenzi A et al (2024) Current status of partial laryngeal surgery for advanced laryngeal cancer: when and why? Curr Oncol Rep 26:614\u201324. https:\/\/doi.org\/10.1007\/s11912-024-01516-7","journal-title":"Curr Oncol Rep"},{"key":"10129_CR2","doi-asserted-by":"publisher","first-page":"18","DOI":"10.21147\/j.issn.1000-9604.2020.01.03","volume":"32","author":"R Nocini","year":"2020","unstructured":"Nocini R, Molteni G, Mattiuzzi C, Lippi G (2020) Updates on larynx cancer epidemiology. Chin J Cancer Res 32:18\u201325. https:\/\/doi.org\/10.21147\/j.issn.1000-9604.2020.01.03","journal-title":"Chin J Cancer Res"},{"key":"10129_CR3","doi-asserted-by":"publisher","first-page":"e35","DOI":"10.1097\/SCS.0000000000003196","volume":"28","author":"O Ismi","year":"2017","unstructured":"Ismi O, Unal M, Vayisoglu Y, Yesilova M, Helvaci I, Gorur K et al (2017) Stapler esophageal closure during total laryngectomy. J Craniofac Surg 28:e35-40. https:\/\/doi.org\/10.1097\/SCS.0000000000003196","journal-title":"J Craniofac Surg"},{"key":"10129_CR4","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1177\/000348941112000510","volume":"120","author":"C Calli","year":"2011","unstructured":"Calli C, Pinar E, Oncel S (2011) Pharyngocutaneous fistula after total laryngectomy: less common with mechanical stapler closure. Ann Otol Rhinol Laryngol 120:339\u2013344. https:\/\/doi.org\/10.1177\/000348941112000510","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"10129_CR5","first-page":"2","volume":"27","author":"R Dedivitis","year":"2007","unstructured":"Dedivitis R, Ribeiro K, Castro M, Nascimento P (2007) Pharyngocutaneous fistula following total laryngectomy. Acta Otorhinolaryngol Ital 27:2\u20135","journal-title":"Acta Otorhinolaryngol Ital"},{"issue":"Suppl 3","key":"10129_CR6","first-page":"S89","volume":"96","author":"P Sannikorn","year":"2013","unstructured":"Sannikorn P, Pornniwes N (2013) Comparison of outcomes for staple and conventional closure of the pharynx following total laryngectomy. J Med Assoc Thai 96(Suppl 3):S89\u201393","journal-title":"J Med Assoc Thai"},{"key":"10129_CR7","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1017\/S0022215120001371","volume":"134","author":"A Sansa-Perna","year":"2020","unstructured":"Sansa-Perna A, Casasayas-Plass M, Rovira-Mart\u00ednez C, L\u00f3pez-Vilas M, Garc\u00eda-Lorenzo J, Quer-Agusti M et al (2020) Pharyngeal closure after a total laryngectomy: mechanical versus manual technique. J Laryngol Otol 134:626\u201331. https:\/\/doi.org\/10.1017\/S0022215120001371","journal-title":"J Laryngol Otol"},{"key":"10129_CR8","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1111\/coa.13702","volume":"46","author":"Y-C Lee","year":"2021","unstructured":"Lee Y-C, Fang T-J, Kuo I-C, Tsai Y-T, Hsin L-J (2021) Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: a systematic review and meta-analysis. Clin Otolaryngol 46:692\u2013698. https:\/\/doi.org\/10.1111\/coa.13702","journal-title":"Clin Otolaryngol"},{"key":"10129_CR9","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s40487-022-00193-5","volume":"10","author":"CM Chiesa-Estomba","year":"2022","unstructured":"Chiesa-Estomba CM, Mayo-Yanez M, Palacios-Garc\u00eda JM, Lechien JR, Viljoen G, Karkos PD et al (2022) Stapler-assisted pharyngeal closure after total laryngectomy: a systematic review and meta-analysis. Oncol Ther 10:241\u201352. https:\/\/doi.org\/10.1007\/s40487-022-00193-5","journal-title":"Oncol Ther"},{"key":"10129_CR10","doi-asserted-by":"publisher","first-page":"4273","DOI":"10.1007\/s00405-024-08696-9","volume":"281","author":"EA Mandor","year":"2024","unstructured":"Mandor EA, Ebada HA, El-Fattah AMA, Kamal E, Baz H, Tawfik A (2024) Stapler versus conventional pharyngeal repair after total laryngectomy: a randomized clinical trial. Eur Arch Otorhinolaryngol 281:4273\u20134280. https:\/\/doi.org\/10.1007\/s00405-024-08696-9","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"10129_CR11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https:\/\/doi.org\/10.1136\/bmj.n71","journal-title":"BMJ"},{"key":"10129_CR12","doi-asserted-by":"publisher","DOI":"10.1002\/9780470712184","volume-title":"Cochrane handbook for systematic reviews of interventions","author":"JP Higgins","year":"2008","unstructured":"Higgins JP, Green S (2008) Cochrane handbook for systematic reviews of interventions. https:\/\/doi.org\/10.1002\/9780470712184"},{"key":"10129_CR13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https:\/\/doi.org\/10.1136\/bmj.l4898","journal-title":"BMJ"},{"key":"10129_CR14","unstructured":"Wells GA, Shea B, O\u2019Connell D, Peterson J, Welch V, Losos M et al The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses 2000"},{"key":"10129_CR15","doi-asserted-by":"publisher","first-page":"363","DOI":"10.5455\/medarh.2022.76.363-367","volume":"76","author":"W Algargaz","year":"2022","unstructured":"Algargaz W, Mohamad I, Eid S, Khanfa A, Abushukair H (2022) Stapler pharyngeal repair versus conventional suturing after laryngectomy in Jordanian laryngeal cancer patients. Med Arch 76:363. https:\/\/doi.org\/10.5455\/medarh.2022.76.363-367","journal-title":"Med Arch"},{"key":"10129_CR16","doi-asserted-by":"publisher","DOI":"10.5306\/wjco.v16.i7.109246","author":"A Galazka","year":"2025","unstructured":"Galazka A, Stawarz K, Bienkowska-Pluta K, Paszkowska M, Misiak-Galazka M (2025) Closure techniques for esophageal reconstruction after total laryngectomy and their impact on fistula formation. World J Clin Oncol. https:\/\/doi.org\/10.5306\/wjco.v16.i7.109246","journal-title":"World J Clin Oncol"},{"key":"10129_CR17","doi-asserted-by":"publisher","first-page":"228","DOI":"10.21037\/jovs.2018.10.10","volume":"4","author":"B Galletti","year":"2018","unstructured":"Galletti B, Freni F, Catalano N, Nicita RA, Bruno R, Galletti C et al (2018) Linear stapler closure of the pharynx in laryngectomy: our experience (endoscopic closed technique). J Vis Surg 4:228\u2013228. https:\/\/doi.org\/10.21037\/jovs.2018.10.10","journal-title":"J Vis Surg"},{"key":"10129_CR18","doi-asserted-by":"publisher","first-page":"E473","DOI":"10.1002\/lary.28737","volume":"131","author":"J Galli","year":"2021","unstructured":"Galli J, Salvati A, Di Cintio G, Mastrapasqua RF, Parrilla C, Paludetti G et al (2021) Stapler use in salvage total laryngectomy: a useful tool? Laryngoscope 131:E473-8. https:\/\/doi.org\/10.1002\/lary.28737","journal-title":"Laryngoscope"},{"key":"10129_CR19","doi-asserted-by":"publisher","unstructured":"Gon\u00e7alves AJ, de Souza aL, Menezes MB, Kavabata NK, Suehara AB, Lehn CN (2009) Pharyngocutaneous fistulae following total laryngectomy comparison between manual and mechanical sutures. Eur Arch Otorhinolaryngol 266:1793\u20138. https:\/\/doi.org\/10.1007\/s00405-009-0945-4","DOI":"10.1007\/s00405-009-0945-4"},{"key":"10129_CR20","doi-asserted-by":"publisher","unstructured":"Han B, Hou L, Hao S, Han Z, Fang J, Wu J (2024) Comparing Closure Techniques for Pharyngeal Mucosa After Total Laryngectomy: Manual Suture, Linear Stapler, and Thyroid Gland Flap-A Retrospective Analysis. Ear Nose Throat J 1455613241282758. https:\/\/doi.org\/10.1177\/01455613241282758","DOI":"10.1177\/01455613241282758"},{"key":"10129_CR21","unstructured":"Dedivitis RA, Aires FT, Pfuetzenreiter EG, a. F M, Guimar\u00e3es AV (2014) Stapler suture of the pharynx after total laryngectomy. Acta Otorhinolaryngol Ital 34:94\u20138"},{"key":"10129_CR22","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1177\/014556131309200815","volume":"92","author":"BA Miles","year":"2013","unstructured":"Miles BA, Larrison D, Myers LL (2013) Comparison of complication rates associated with stapling and traditional suture closure after total laryngectomy for advanced cancer. Ear Nose Throat J 92:392\u2013399. https:\/\/doi.org\/10.1177\/014556131309200815","journal-title":"Ear Nose Throat J"},{"issue":"4","key":"10129_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.otot.2025.03.001","volume":"36","author":"A Nosiglia","year":"2025","unstructured":"Nosiglia A, Cambi J, Boccuzzi S, Pancrazzi T, Ciabatti PG (2025) Comparative analysis of pharyngeal closure techniques in total laryngectomy for squamous cell carcinoma: traditional 3-layered manual suture vs. ECHELON\u2122 automatic stapler. A multicentric experience. Oper Tech Otolaryngol Head Neck Surg S1043181025000168. https:\/\/doi.org\/10.1016\/j.otot.2025.03.001","journal-title":"Oper Tech Otolaryngol Head Neck Surg"},{"key":"10129_CR24","doi-asserted-by":"publisher","first-page":"166","DOI":"10.5152\/tao.2019.4469","volume":"57","author":"K \u00d6zt\u00fcrk","year":"2019","unstructured":"\u00d6zt\u00fcrk K, Turhal G, \u00d6zt\u00fcrk A, Kaya \u0130, Aky\u0131ld\u0131z S, Ulu\u00f6z \u00dc (2019) The comparative analysis of suture versus linear stapler pharyngeal closure in total laryngectomy: a prospective randomized study. Turk Arch Otorhinolaryngol 57:166\u2013170. https:\/\/doi.org\/10.5152\/tao.2019.4469","journal-title":"Turk Arch Otorhinolaryngol"},{"key":"10129_CR25","doi-asserted-by":"publisher","first-page":"315","DOI":"10.14639\/0392-100X-N3138","volume":"45","author":"C Parrilla","year":"2025","unstructured":"Parrilla C, Rossi G, Longobardi Y, Perna L, Rigante M, Pacilli MC et al (2025) Stapler-assisted total laryngectomy and hybrid primary puncture: analysis of functional results. Acta Otorhinolaryngol Ital 45:315\u201321. https:\/\/doi.org\/10.14639\/0392-100X-N3138","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"10129_CR26","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1017\/S0022215124001269","volume":"139","author":"AA Paulose","year":"2025","unstructured":"Paulose AA, Michael RC, Ramalingam N, Riju J, Gowri SM, Abraham L et al (2025) A matched pair analysis of outcomes after stapler-assisted pharyngeal closure following laryngectomy. J Laryngol Otol 139:78\u201384. https:\/\/doi.org\/10.1017\/S0022215124001269","journal-title":"J Laryngol Otol"},{"key":"10129_CR27","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1007\/s12070-023-03587-7","volume":"75","author":"G Salzano","year":"2023","unstructured":"Salzano G, Maglitto F, Calvanese C, Apolito M, Buono S, Franco P et al (2023) Pharyngocutaneous fistula in salvage laryngectomy: use of the stapler versus manual suturing technique. Indian J Otolaryngol Head Neck Surg 75:1441\u20136. https:\/\/doi.org\/10.1007\/s12070-023-03587-7","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"10129_CR28","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1177\/00034894241308403","volume":"134","author":"AA Teaima","year":"2025","unstructured":"Teaima AA, Mostafa BE, Nabil KM, Mady OM (2025) Stapler versus manual suturing for pharyngeal closure in total laryngectomy. Ann Otol Rhinol Laryngol 134:320\u2013325. https:\/\/doi.org\/10.1177\/00034894241308403","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"10129_CR29","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1007\/s12070-020-02086-3","volume":"74","author":"O Ahmed","year":"2022","unstructured":"Ahmed O, Abdel-Fattah HM, Elbadan HEM (2022) Stapler assisted total laryngectomy: a prospective randomized clinical study. Indian J Otolaryngol Head Neck Surg 74:2205\u20132213. https:\/\/doi.org\/10.1007\/s12070-020-02086-3","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"10129_CR30","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1097\/00005537-200008000-00035","volume":"110","author":"RA Sofferman","year":"2000","unstructured":"Sofferman RA, Voronetsky I (2000) Use of the linear stapler for pharyngoesophageal closure after total laryngectomy. Laryngoscope 110:1406\u20131409. https:\/\/doi.org\/10.1097\/00005537-200008000-00035","journal-title":"Laryngoscope"},{"key":"10129_CR31","doi-asserted-by":"crossref","unstructured":"Wu SJ (2021) A Multifunctional Patch for Minimally Invasive Tissue Sealing. Design Strategies and Applications","DOI":"10.1002\/adma.202007667"},{"key":"10129_CR32","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.01390","volume":"10","author":"J Meulemans","year":"2020","unstructured":"Meulemans J, Demarsin H, Debacker J, Batailde G, Mennes T, Laenen A et al (2020) Functional outcomes and complications after salvage total laryngectomy for residual, recurrent, and second primary squamous cell carcinoma of the larynx and hypopharynx: a multicenter retrospective cohort study. Front Oncol 10:1390. https:\/\/doi.org\/10.3389\/fonc.2020.01390","journal-title":"Front Oncol"},{"key":"10129_CR33","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1597538","volume":"15","author":"C Piazza","year":"2025","unstructured":"Piazza C, Montenegro C, Vander Poorten V (2025) Preventing and managing pharyngocutaneous fistula after total laryngectomy - a narrative review. Front Oncol 15:1597538. https:\/\/doi.org\/10.3389\/fonc.2025.1597538","journal-title":"Front Oncol"},{"key":"10129_CR34","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1097\/00005537-199604000-00018","volume":"106","author":"Y Hui","year":"1996","unstructured":"Hui Y, Wei WI, Yuen PW, Lam LK, Ho WK (1996) Primary closure of pharyngeal remnant after total laryngectomy and partial pharyngectomy: how much residual mucosa is sufficient? Laryngoscope 106:490\u20134. https:\/\/doi.org\/10.1097\/00005537-199604000-00018","journal-title":"Laryngoscope"},{"key":"10129_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2024.104512","volume":"46","author":"RT Judd","year":"2025","unstructured":"Judd RT, Godsell J, Kuhar H, McCrary H, Farlow J, Agrawal A et al (2025) Revisiting the closed stapler laryngectomy: technique and review of recent evidence. Am J Otolaryngol 46:104512. https:\/\/doi.org\/10.1016\/j.amjoto.2024.104512","journal-title":"Am J Otolaryngol"},{"key":"10129_CR36","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.21037\/apm-22-1475","volume":"12","author":"T-H Chiu","year":"2023","unstructured":"Chiu T-H, Shih H-S, Jeng S-F (2023) A review of pharyngocutaneous fistula management in head and neck malignancies. Ann Palliat Med 12:1081\u20131088. https:\/\/doi.org\/10.21037\/apm-22-1475","journal-title":"Ann Palliat Med"},{"key":"10129_CR37","first-page":"118","volume":"27","author":"G Altissimi","year":"2007","unstructured":"Altissimi G, Frenguelli A (2007) Linear stapler closure of the pharynx during total laryngectomy: a 15-year experience (from closed technique to semi-closed technique). Acta Otorhinolaryngol Ital 27:118\u2013122","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"10129_CR38","doi-asserted-by":"publisher","first-page":"e338","DOI":"10.1055\/s-0039-1685155","volume":"23","author":"E Allegra","year":"2019","unstructured":"Allegra E, Mantia IL, Azzolina A, Natale MD, Trapasso S, Saita V (2019) Total laryngectomy with horizontal mechanical closure of the pharyngoesophagectomy: evaluation of the effectiveness in elderly patients. Int Arch Otorhinolaryngol 23:e338\u2013e342. https:\/\/doi.org\/10.1055\/s-0039-1685155","journal-title":"Int Arch Otorhinolaryngol"},{"key":"10129_CR39","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/j.jaci.2006.03.027","volume":"117","author":"AH Liu","year":"2006","unstructured":"Liu AH, Leung DYM (2006) Renaissance of the hygiene hypothesis. J Allergy Clin Immunol 117:1063\u20131066. https:\/\/doi.org\/10.1016\/j.jaci.2006.03.027","journal-title":"J Allergy Clin Immunol"},{"key":"10129_CR40","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1002\/hed.20280","volume":"27","author":"L Bedrin","year":"2005","unstructured":"Bedrin L, Ginsburg G, Horowitz Z, Talmi YP (2005) 25-year experience of using a linear stapler in laryngectomy. Head Neck 27:1073\u20131079. https:\/\/doi.org\/10.1002\/hed.20280","journal-title":"Head Neck"},{"key":"10129_CR41","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.1002\/lary.23443","volume":"122","author":"HN White","year":"2012","unstructured":"White HN, Golden B, Sweeny L, Carroll WR, Magnuson JS, Rosenthal EL (2012) Assessment and incidence of salivary leak following laryngectomy. Laryngoscope 122:1796\u20131799. https:\/\/doi.org\/10.1002\/lary.23443","journal-title":"Laryngoscope"},{"key":"10129_CR42","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1002\/lary.26208","volume":"127","author":"P Paddle","year":"2017","unstructured":"Paddle P, Husain I, McHugh L, Franco R (2017) Outcomes of mechanical stapling for postlaryngectomy open pharyngotomy closure. Laryngoscope 127:605\u201310. https:\/\/doi.org\/10.1002\/lary.26208","journal-title":"Laryngoscope"},{"key":"10129_CR43","first-page":"437","volume":"29","author":"J Park","year":"2004","unstructured":"Park J, Lee KC (2004) The influence of salivary contamination on shear bond strength of dentin adhesive systems. Oper Dent 29:437\u2013442","journal-title":"Oper Dent"},{"key":"10129_CR44","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.anl.2015.04.002","volume":"42","author":"J-W Liang","year":"2015","unstructured":"Liang J-W, Li Z-D, Li S-C, Fang F-Q, Zhao Y-J, Li Y-G (2015) Pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis of risk factors. Auris Nasus Larynx 42:353\u2013359. https:\/\/doi.org\/10.1016\/j.anl.2015.04.002","journal-title":"Auris Nasus Larynx"},{"key":"10129_CR45","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1002\/hed.23326","volume":"36","author":"FT Aires","year":"2014","unstructured":"Aires FT, Dedivitis RA, Castro MAF, Bernardo WM, Cernea CR, Brand\u00e3o LG (2014) Efficacy of stapler pharyngeal closure after total laryngectomy: a systematic review. Head Neck 36:739\u2013742. https:\/\/doi.org\/10.1002\/hed.23326","journal-title":"Head Neck"},{"key":"10129_CR46","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.soard.2012.10.009","volume":"9","author":"E Contini","year":"2013","unstructured":"Contini E, Whiffen J, Bronson D (2013) Comparison of endostapler performance in challenging tissue applications. Surg Obes Relat Dis 9:417\u2013421. https:\/\/doi.org\/10.1016\/j.soard.2012.10.009","journal-title":"Surg Obes Relat Dis"},{"key":"10129_CR47","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1017\/s0022215100094974","volume":"97","author":"GA Westmore","year":"1983","unstructured":"Westmore GA, Knowles JE (1983) The use of a stapling instrument for postlaryngectomy pharyngeal repair. J Laryngol Otol 97:775\u2013778. https:\/\/doi.org\/10.1017\/s0022215100094974","journal-title":"J Laryngol Otol"},{"key":"10129_CR48","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1017\/S0022215109990879","volume":"124","author":"JR Tysome","year":"2010","unstructured":"Tysome JR, Duxbury M, Huddart S (2010) Hydrogen peroxide aids assessment of pharyngeal closure after laryngectomy. J Laryngol Otol 124:204\u2013205. https:\/\/doi.org\/10.1017\/S0022215109990879","journal-title":"J Laryngol Otol"},{"issue":"3 Suppl","key":"10129_CR49","doi-asserted-by":"publisher","first-page":"e59","DOI":"10.1016\/j.jacl.2025.04.081","volume":"19","author":"B Abd","year":"2025","unstructured":"Abd B, Man AM, Yassin A, Mills MAM (2025) Sex differences in cardiovascular outcomes among patients with elevated lipoprotein(a). J Clin Lipidol 19(3 Suppl):e59\u201360. https:\/\/doi.org\/10.1016\/j.jacl.2025.04.081","journal-title":"J Clin Lipidol"},{"key":"10129_CR50","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-025-07807-w","author":"A Shu","year":"2025","unstructured":"Shu A, Rak MS, Elg MS (2025) Clinical outcomes in anemic women undergoing elective percutaneous coronary intervention: a retrospective cohort analysis. Cardiovasc Drugs Ther. https:\/\/doi.org\/10.1007\/s10557-025-07807-w","journal-title":"Cardiovasc Drugs Ther"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10129-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-026-10129-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10129-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T20:06:03Z","timestamp":1784664363000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-026-10129-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":50,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10129"],"URL":"https:\/\/doi.org\/10.1007\/s00405-026-10129-8","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]},"assertion":[{"value":"2 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Clinical trial number","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No conflict of interest.","order":3,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors did not use any AI technologies during the preparation of this manuscript.","order":4,"name":"Ethics","label":"Declaration of generative AI and AI-assisted technologies in the writing process","group":{"name":"EthicsHeading","label":"Declarations"}}]}}