Tube esophagostomy. A new technique in the management of long-term swallowing disorders.

Surgeons whose patients require long-term management of nutritional intake must usually choose from among nasogastric tube feedings, hyperalimentation by intravenous route, and/or gastrostomy. Cervical esophagostomy has been a useful but not widely employed alternative. The advantages of cervical esophagostomy over other modalities include the avoidance of laparotomy, absence of a nasogastric tube, and lack of the complications of a long-term indwelling intravenous catheter. The disadvantages of standard esophagostomy include the need to wear a tube to keep the fistula open, leakage, and skin irritation. Dobie et al presented a skin flap esophagostomy technique in 1978. We report a variation of this concept that has resulted in no salivary leakage and that allows the patient to dispense a tube between feedings. It provides a directional stoma in which the internal orifice is considerably inferior to the external one, resulting in continence and thus preventing substantial leakage.