Pharyngostomy tubes for gastric conduit decompression

Rueth, Natasha M.; Lee, Natasha; Groth, Shawn S.; Stranberg, Sarah C.; Maddaus, Michael A.; D'Cunha, Jonathan; Andrade, Rafael S.

doi:10.1016/j.jtcvs.2010.02.043

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 2 , Pages 373-376, August 2010

Pharyngostomy tubes for gastric conduit decompression

Natasha M. Rueth, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Natasha Lee
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Shawn S. Groth, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Sarah C. Stranberg, MA, CCC-SLP
- Rehabilitation Services, University of Minnesota Medical Center, Fairview, Minneapolis, Minn
Michael A. Maddaus, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Jonathan D'Cunha, MD, PhD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Rafael S. Andrade, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
- Veterans Administration Medical Center, Minneapolis, Minn
- Address for reprints: Rafael S. Andrade, MD, MMC195, 420 Delaware Street SE, Minneapolis, MN 55455.

Received 17 October 2009; received in revised form 25 January 2010; accepted 26 February 2010. published online 15 April 2010.

Objective

This article illustrates our operative technique for pharyngostomy tube placement and describes our clinical experience with pharyngostomy use for gastric conduit decompression after esophagectomy.

Methods

We retrospectively reviewed patients undergoing pharyngostomy tube placement for gastric conduit decompression after esophagectomy from January 2008 to August 2009. Patients were included if they had a pharyngostomy tube placed at esophagectomy (prophylactic placement) or as a means of decompression after postesophagectomy anastomotic leak (therapeutic placement). We collected operative and clinical data and performed a descriptive statistical analysis.

Results

We placed 25 pharyngostomy tubes for gastric conduit decompression after esophagectomy. Eleven were placed prophylactically (44%); the remaining 14 were placed therapeutically (56%) after anastomotic leak. Prophylactic pharyngostomy tubes remained in place a median of 8 days (range 4–17 days), whereas therapeutic pharyngostomy tubes were left in place a median of 15 days (range 7–125 days). There were 4 infectious complications (16%) unrelated to length of pharyngostomy use: 2 cases of cellulitis (resolved with antibiotics, tube remaining in place) and 2 superficial abscesses after tube removal requiring bedside débridement. Seventy-two percent of patients underwent swallow evaluation; 22% of these patients had radiographic evidence of aspiration.

Conclusions

Pharyngostomy tube placement for gastric conduit decompression after esophagectomy is simple, and tubes can stay in place for prolonged periods. Our experience suggests that pharyngostomy tubes are a safe alternative to nasogastric drainage.

CTSNet classification: 7, 8.7

Abbreviations and Acronyms: NGT, nasogastric tube, PT, pharyngostomy tube