Transcervical gastric tube drainage facilitates patient mobility and reduces the risk of pulmonary complications after esophagectomy.
BACKGROUND
Standard nasogastric decompression following esophagectomy is associated with reduced patient comfort and mobility and impaired hypopharyngeal function--predisposing the patient to sinusitis, pharyngitis, and the risk of aspiration. In this study, we evaluate the results of the transcervical gastric tube drainage in the setting of esophagectomy.


METHODS
Transcervical gastric tube decompression was performed on 145 consecutive patients undergoing open esophagectomy between 2003 and 2007. Postoperative outcome variables include morbidity, mortality, esophagostomy duration, and length of stay.


RESULTS
There were 107 males and 38 females (median age = 66; range = 37-87). Perioperative mortality was 2.8%. Major complications included five anastomotic leaks (3.4%), ten pneumonias (6.9%), two myocardial infarctions (1.4%), and the need for reoperation in four patients (bleeding, dehiscence). Median duration of transcervical drainage was 8 days. No tubes were dislodged prematurely. There were no bleeding complications. Four patients developed cellulitis near the cervical gastric tube site and were treated successfully with antibiotics and/or tube removal.


CONCLUSIONS
Transcervical gastric decompression can be performed safely with minimal complication risk. Inadvertent tube removal was not encountered in this series. The use of this technique may help to promote accelerated patient mobilization, greater patient comfort, and a durable means of gastric decompression.
Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Shadyside Medical Building-Suite 715, 5200 Centre Avenue, Pittsburgh, PA 15232, USA. schuchertmj@upmc.edu
Matthew J
MJ
Schuchert
Brian L
BL
Pettiford
Joshua P
JP
Landreneau
Jonathon
J
Waxman
Arman
A
Kilic
Ricardo S
RS
Santos
Michael S
MS
Kent
Amgad
A
El-Sherif
Ghulam
G
Abbas
James D
JD
Luketich
Rodney J
RJ
Landreneau
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D015331:Cohort Studies; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D013270:Stomach / Q000601:surgery; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome