Soft tissue-anchored transcutaneous port attached to an intestinal tube for long-term gastroduodenal infusion of levodopa/carbidopa in Parkinson disease.
OBJECTIVE
To report experiences with a transcutaneous soft tissue-anchored titanium port (T-port) attached to an intestinal tube for gastroduodenal infusion of levodopa/carbidopa in patients with Parkinson disease, and to describe and analyze complications related to the T-port, gastrostomy technique, and intestinal tube placement.


METHODS
The T-port implantation and gastrostomy were done under local anesthesia in 15 patients (mean age, 64 years; range, 52-74 y). An intestinal tube (10 F) was attached to the T-port for duodenal/jejunal access. Three versions of the T-port have been tested (generations I-III).


RESULTS
Our experience with T-ports covers 34.5 patient-years (mean, 2.3 y per patient). Maximum duration of use was 4.9 years. The major complications were perforation of the skin by the straight flange (three of five generation I ports), local infections (12 of 15 patients) resulting from leakage of levodopa/carbidopa (five of 11 generation II ports), problems with T-fasteners, and poor hygiene. Hypergranulation tissue was often seen as a result of local inflammation/infection resulting from levodopa/carbidopa leakage, poor hygiene, and/or an overly mobile T-port. The last version of the T-port (generation III), with more optimized implantation and gastrostomy techniques, seemed to considerably improve the results.


CONCLUSIONS
The initial experience with the T-port system reveals that it may be a useful alternative to presently used gastrojejunostomy tubes. Several improvements of the T-port and placement technique were made. The T-port offers a potential advantage compared with standard techniques from an aesthetic point of view.
Nyman
Rickard
R
Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden. rickard.nyman@akademiska.se
Lundgren
Dan
D
Nyholm
Dag
D
D000978:Antiparkinson Agents / Q000008:administration & dosage; D002230:Carbidopa / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D003238:Connective Tissue / Q000601:surgery*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000295:instrumentation* / Q000379:methods; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa; D002230:Carbidopa