The Pharyngostomy Tube: Indications, Technique, Efficacy, and Safety in Modern Surgical Practice
02 August 2016
22 September 2016
17 November 2016 (eFirst)
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.
- 1 Edge CJ, Langdon JD. Complications of pharyngostomy. Br J Oral Maxillofac Surg 1991; 29 (4) 237-240
- 2 Wrenn K. The lowly nasogastric tube: still appropriate after all these years (at times). Am J Emerg Med 1993; 11 (1) 84-89
- 3 Pillai JB, Vegas A, Brister S. Thoracic complications of nasogastric tube: review of safe practice. Interact Cardiovasc Thorac Surg 2005; 4 (5) 429-433
- 4 Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J 2002; 78 (918) 198-204
- 5 Desmond P, Raman R, Idikula J. Effect of nasogastric tubes on the nose and maxillary sinus. Crit Care Med 1991; 19 (4) 509-511
- 6 Royster HP, Noone RB, Graham III WP, Theogaraj SD. Cervical pharyngostomy for feeding after maxillofacial surgery. Am J Surg 1968; 116 (4) 610-614
- 7 Lyons Jr JH. Cervical pharyngostomy. A safe alternative for gastrointestinal decompression. Am J Surg 1974; 127 (4) 387-391
- 8 Klopp CT. Cervical esophagostomy. J Thorac Surg 1951; 21 (5) 490-491
- 9 Kendrick ML, Sarr MG. Prolonged gastrointestinal decompression of the inoperable abdomen: the forgotten tube pharyngostomy. J Am Coll Surg 2000; 191 (2) 221-223
- 10 Shumrick EA. Pyriform sinusostomy. Arch Surg 1967; 94: 277-279
- 11 Graham III WP, Royster HP. Simplified cervical esophagostomy for long term extraoral feeding. Surg Gynecol Obstet 1967; 125 (1) 127-128
- 12 Atkins BZ, Shah AS, Hutcheson KA , et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004; 78 (4) 1170-1176 , discussion 1170–1176
- 13 Bauer JJ, Gelernt IM, Salky BA, Kreel I. Is routine postoperative nasogastric decompression really necessary?. Ann Surg 1985; 201 (2) 233-236
- 14 Abdelfatah MM, Garg A, Sarr MG. Tube pharyngostomy--a useful alternative for long-term enteric decompression or enteral feeding. J Gastrointest Surg 2012; 16 (12) 2318-2320
- 15 Gaggiotti G, Orlandoni P, Boccoli G, Caporelli SG, Patrizi I, Masera N. A device to perform percutaneous cervical pharyngostomy (PCP) for enteral nutrition. Clin Nutr 1989; 8 (5) 273-275
- 16 R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2009
- 17 Rueth NM, Lee N, Groth SS , et al. Pharyngostomy tubes for gastric conduit decompression. J Thorac Cardiovasc Surg 2010; 140 (2) 373-376
- 18 Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg 2005; 92 (6) 673-680
- 19 Verma R, Nelson RL. Prophylactic nasogastric decompression after abdominal surgery. Database Syst Rev 2007; 3: 1-49
- 20 Leder SB, Bayar S, Sasaki CT, Salem RR. Fiberoptic endoscopic evaluation of swallowing in assessing aspiration after transhiatal esophagectomy. J Am Coll Surg 2007; 205 (4) 581-585
- 21 Keeling WB, Lewis V, Blazick E, Maxey TS, Garrett JR, Sommers KE. Routine evaluation for aspiration after thoracotomy for pulmonary resection. Ann Thorac Surg 2007; 83 (1) 193-196