BACKGROUND The pharyngocutaneous fistula is troublesome complication after total laryngectomy. Despite a large number of studies, there is still disagreement on factors predisposing to this complication. METHODS A retrospective analysis of pharyngocutaneous fistulas in 133 patients in whom total laryngectomy was performed. RESULTS Fistulas were found in 15% of the patients. Spontaneous closure was noted in 80%. Simultaneous laryngectomy and partial pharyngectomy or neck dissection increased the risk of fistula formation. Preoperative irradiation, short interval between radiotherapy and operation, and cobalt/roentgen radiation instead of photons predispose to this complication. The fistulas appeared earlier, and the sizes of fistulas were significantly larger in patients with previous irradiation than those in patients with no preoperative irradiation. CONCLUSIONS Postoperative pharyngocutaneous fistulas significantly increase patients' morbidity and hospital stay. Good surgical technique and postoperative treatment should be paid attention to patients with an increased risk of pharyngocutaneous fistula formation.