The Pharyngostomy Tube: Indications, Technique, Efficacy, and Safety in Modern Surgical Practice.

BACKGROUND: Long-term nasogastric tubes are uncomfortable and associated with complications such as impairment with speech and swallowing, septum trauma, epistaxis, alar necrosis, and intubation of the trachea among others. Pharyngostomy tubes (PTs) are an alternative for prolonged enteral feeding, transluminal drainage of collections, and gastric decompression in patients with an intestinal obstruction and an inoperable abdomen. PATIENTS AND METHODS: This is a retrospective analysis of patients who had a PT placed at our institution from May 2005 to March 2015. The primary end point of the study was to establish the type and rate of complications and aspiration events related to PT use. RESULTS: During the specified period, a total of 84 PTs were placed. The most common indication for PT placement was enteric decompression in 65 (77.4%), followed by transluminal collection drainage in 12 (14.3%), and enteral access for nutrition in 7 (8.3%) patients. The mean time to tube removal was 17.8 days ± 17.1 (range, 2-119). We encountered 10 (11.2%) complications related to PT placement, including 7 cases of cellulitis, 2 superficial abscesses, and 1 patient with pharyngeal hemorrhage. CONCLUSION: PTs are a relatively simple, safe, and straightforward approach to achieve long-term enteral decompression, access for feeding or transluminal drainage, avoiding the complications associated with prolonged nasogastric tube placement. The complication rate is low and patient satisfaction and compliance appear to be higher than with nasogastric tubes. Modern surgeons should be familiar with the procedure and technique. PTs should be part of every surgeon's armamentarium.

A novel surgical method of managing a high output pharyngostome.

Pharyngocutaneous fistulas following large oncological surgical resection of the upper aerodigestive tract are common and typically heal over a number of weeks. A pharyngostome is a surgically created non-healing opening into the pharynx, which is far less common and often difficult to manage.

Pharyngostomy tubes for gastric conduit decompression.

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.

Cervical pharyngostomy: an old technique revisited.

OBJECTIVE: To review our experience with pharyngostomy tubes used to manage complications following foregut surgery and to discuss technical aspects of insertion. SUMMARY BACKGROUND DATA: Cervical pharyngostomy tubes are percutaneously placed through the hypopharynx and directed into the stomach or small bowel. Historically, these tubes were placed during resection of head and neck cancer for postoperative nutrition. The technique may also be used to manage a variety of complications following esophagectomy or gastric surgery. METHODS: A retrospective review identified all patients who underwent pharyngostomy tube placement at the University of Pittsburgh Medical Center from 1995 to 2007. Indications, procedure-related complications, and duration of tube placement were recorded. RESULTS: Thirty-eight patients were identified. Indications for tube placement were: access for enteral nutrition (n = 18), drainage of mediastinal abscess (n = 4), gastric decompression (n = 13), and other (n = 3). Procedure-related complications included: cellulitis (n = 1), esophagitis (n = 1), aspiration pneumonia (n = 1), and tube migration (n = 9). Duration of tube placement was 51 days (range 1-279). No major complications occurred. CONCLUSIONS: Pharyngostomy tubes may be useful in the management of complications following esophageal or gastric surgery. They are more comfortable than nasogastric tubes and may be kept in place for several months if necessary. Bleeding or other major complications have not occurred in our experience.

Vías de acceso quirúrgico en nutrición enteral / Surgical access routes in enteral nutrition

Son múltiples las vías de acceso al tubo digestivo para la nutrición enteral (NE) que conocemos y que en los últimos años ha experimentado importantes avances. Igualmente han avanzado considerablemente tanto las técnicas de administración como los productos nutricionales. La colocación de estos sistemas puede ser temporal o permanente. Sus indicaciones a menudo se superponen. Si es factible, siempre la vía enteral es la preferida respecto de la parenteral. Si ésta es necesaria durante 6 semanas o menos, las sondas nasoenterales son la mejor opción, por el contrario, las sondas de enterostomía serían las indicadas en la NE que supere las 6 semanas y la gastrostomía endoscópica percutánea (PEG) es el procedimiento de elección. El acceso pospilórico debe considerarse en pacientes con alto riesgo de aspiración. Finalmente, la yeyunostomía con catéter fino en el curso de una intervención quirúrgica del tracto gastrointestinal superior es la técnica ideal para iniciar la NE precoz. Todas las técnicas continúan teniendo alguna vigencia y sólo la situación clínica del enfermo y la experiencia del equipo que los atiende determinarán su uso. Este trabajo consta de dos partes. En la primera se analizan las técnicas de acceso quirúrgico en NE, sus indicaciones, contraindicaciones y las complicaciones más frecuentes relacionadas con la técnica, con el cuidado del estoma y con el material de intubación. En la segunda se aportan datos de nuestra experiencia en el tema, con las diversas técnicas que hemos realizado, en qué pacientes y con qué resultados y complicaciones. En total, 287 procedimientos: 48 gastrostomías quirúrgicas, 40 según la técnica de Fontan o Stamm y 8 gastrostomías de Janeway, 27 de ellas permanentes; 169 catéteres de yeyunostomía con una permanencia media de 29,05 ± 21,9 días y 72 sondas nasoyeyunales de doble luz (AU)

There are many known routes of access to the digestive tract for enteral nutrition (EN) and significant advances have been made in recent years. Administration techniques and nutritional products have also improved. Placement of these systems may be temporary or permanent. Indications often overlap. If feasible, the enteral route is preferred over the parenteral route. When enteral nutrition will last = 6 weeks, enterostomy tubes are indicated and the procedure of choice is percutaneous endoscopic gastrostomy. Postpyloric access should be considered in patients with a high risk of aspiration. Finally, needle catheter jejunostomy during interventions in the upper gastrointestinal tract is the ideal technique for initiating early EN. All these techniques continue to be valid and the choice of procedure will be determined by the patient's clinical status and the experience of the team. The present article is divided into two parts. In the first part, surgical access techniques for EN, their indications and contraindications and the most frequent complications related to the technique, the care of the stoma and the intubation material are analyzed. In the second part, we report data from our personal experience of the various techniques we have performed and describe the patients, results and complications. A total of 287 procedures were performed: 48 surgical gastrostomies, 40 using the technique of Fontan or Stamm, and 8 Janeway gastrostomies; 27 of these procedures were permanent. There were 169 jejunostomy catheters, with a mean dwelling time of 29.05 ± 21.9 days, and 72 double lumen nasojejunal tubes (AU)

Percutaneous cervical pharyngostomy: a traditional technique revisited.

Enteral tube feeding is widely used in intensive care units, high dependency units and general wards. In some patients, an adequate intake is not maintained because patients cannot tolerate the tube. Insertion of an enteral feeding tube via a pharyngostomy is simple and potentially more easily tolerated. We describe our experience with three critically ill patients, using disposable vascular access equipment and a dilational technique. All three patients received markedly increased nutrition, but one patient suffered haemorrhagic complications.

Peptic ulcer-induced acute aortogastric fistula occurring 7 years after a pharyngogastrostomy following a resection for carcinoma of the esophagus: report of a case.

A 46-year-old woman underwent a pharyngogastrostomy, following a laryngoesophagectomy for esophageal carcinoma. Although she had been disease-free for 7 years, she subsequently was admitted to undergo a workup due to fever along with chest and back pain. A few days after admission, the patient suddenly vomited a large volume of blood and went into shock. Bleeding was stopped with a Sengstaken-Blakemore tube, and an emergency thoracotomy was performed. A fistula between the thoracic aorta and an ulcer of the gastric tube was identified. We decided to close the aortic lesion directly because the adhesions were extremely dense and her blood circulation was poor. One week later, we resected the thoracic part of the gastric tube, debrided the fistula, and wrapped the aortic lesion with a patch. However, on the 18th postoperative day, she developed massive hematemesis due to rupture of an infected pseudoaneurysm in the thoracic aorta and died.

Complications of pharyngostomy.

An account is given of a fatal complication following the use of a pharyngostomy feeding tube. The literature on this topic is reviewed with regard to complications. Of the 671 patients that have been reported previously there have been no fatal or serious complications and minor complications were reported in only 42 patients. We regard the technique of pharyngostomy to be safe but recommendations are made to avoid the complication reported here.

Is the laryngoplasty a successful method after total laryngectomy?

Laryngoplasty as outlined by STAFFIERI (1973) is a new surgical technique for vocal rehabilitation after total laryngectomy. After the creation of the neoglottis however many complications such as aspiration and narrowing occur. Out of 36 patients who underwent total laryngectomy and vocal rehabilitation with the technique of Staffieri 13 achieved a good result. Twenty-three patients failed to develop voice production as a result of altered swallowing function.