Ten-year experience with cervical miniesophagostomy

This report describes our experience with 35 patients who underwent intraoperative transcutaneous cervical miniesophagostomy (TCME) during conservation laryngeal and/or hypopharyngeal surgery. The TCME was designed to provide enteral alimentation without the need for a nasogastric tube. Nasogastric tubes may cause posterior laryngeal inflammation, granulations, muscle damage, and vocal cord immobility. Friction between nasogastric and tracheotomy tubes may result in damage to the remaining posterior larynx and may delay healing, oral feeding, and decannulation. Percutaneous endoscopic or radiologically assisted gastrostomy is a possible solution. However, it requires time, special expertise, and coordination with other specialties. In addition, immediate and delayed abdominal complications may occur. The TCME is a relatively simple and quick procedure that is performed during the primary cancer surgery by the head and neck surgeon. It requires no special equipment. It takes about 5 minutes to perform and, if done correctly with tunneling under the skin flaps, is associated with minimal or no postoperative morbidity. It is useful after supraglottic laryngectomy, partial laryngectomy, partial laryngopharyngectomy, and base of tongue resection, and in selected cases of vertical hemilaryngectomy and anterolateral laryngectomy. In the last group, we found that TCME is required if the arytenoid cartilage is removed and the posterior aspect of the larynx is disrupted. There were only minor complications related to TCME. Leakage from the miniesophagostomy did not occur, primarily because of the superior-to-inferior orientation of the tube and the long subplatysmal tunneling before esophageal entrance.