Insertion
of a Soft Silastic Nasogastric Tube at Operation Esophageal Atresia: A New Technical Method ByY.Sweed,
J.A. Bar-Maor, Haifa,
for
and G. Shoshany
Israel
l A new and simple technical method for insertion of a soft silastic nasogastric tube into the stomach in neonates born with esophageal atresia is described. The technique is simple, easy to perform, and enables feeding the baby through this tube a day after the operation. Our method is based on the principle used in insertion of Broviac-Hickman catheters, namely the use of a “peel-away sheath” through which the silastic feeding tube is threaded. We have used this technique in five patients with esophageal atresia without any complication. Copyright Q 1992 by W.B. Saunders Company INDEX WORDS:
Esophageal atresia.
E
NTERAL FEEDING is superior to intravenous alimentation. It is more physiological and is almost without complications. To achieve this goal after repair of esophageal atresia, many pediatric surgeons perform a gastrostomy.’ Others will pass a soft nasogastric feeding tube through the esophageal anastomosis into the stomach at the time of the operation. The usual technique for the passage of the feeding tube through the nose into the stomach is not without complications, not to mention sterility breakage.
MATERIALS
AND METHODS
After performing half of the anastomosis (posterior wall) between the upper and lower segments of the esophagus, a soft and sterile feeding tube (5F) is introduced into a Nelaton catheter (12F). in which its proximal 2 cm were cut off (Fig 1). The combined feeding tube and the Nelaton catheter is then passed aseptically through the nose of the baby by the anaesthetist to the level of the uncompleted anastomosis (Figs 1A and 1B). Once the tip of the Nelaton catheter is visible in the anastomosis, its end is cleaned by iodine solution and pulled out for about 2 cm. Next the rounded end of the Nelaton catheter is cut off while taking care to prevent any damage to the tip of the feeding tube (Fig 1C).
From the Department of Pediatric Surgety~ Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Date accepted: February 22, 1991. Address reprint requests to Professor J.A. Bar-Maor, MD, FACS, FAAP, Chief Department of Pediatric Surgery Rambam Medical Center, Haifa 31096, Israel. Copyright o 1992 by W.B. Saunders Company 0022-3468/9212705-0029$03.OOiO
650
Fig 1. (A and B) The silastic feeding tube, inside the Nelaton catheter is passed through the nose to the region of the anastomosis. (C)The rounded end of the Nelaton catheter is cut off. (D) The feeding tube is pushed forward by the anesthetist and grasped by an anatomical forceps. (E) Pulling out the Nelaton catheter while the surgeon holds the feeding tube in place. (F) The silastic feeding tube in place. (G) Peeling off the Nelaton catheter from the feeding tube.
The feeding tube is pushed forward by the anesthetist for 1 cm and grasped by the surgeon with an anatomical forceps. It is pulled into the anastomosis for a few centimeters and simultaneously pushed into the stomach through the distal esophagus. The Nelaton catheter is then withdrawn by the anesthetist while the surgeon secures the feeding tube in place (Fig 1E) (care must be taken not to displace the endotracheal tube at all stages of the passage of the feeding tube). Closure of the anterior wall of the esophagus completes the procedure (Fig 1F). At the end of the operation the surgeon opens longitudinally the Nelaton catheter by scissors and it is peeled away from the feeding tube (Fig 1G); the “peeling away” is necessary to preserve the proximal end of the silastic tube, which is wider than the Nelaton catheter, due to the presence of its connecting hub. The feeding tube is then fixed properly to the baby’s face. DISCUSSION
A technical method is described, by which a soft silastic feeding tube is passed through the esophagoesophageal anastomosis and into the stomach in cases of esophageal atresia. Coiling of the soft silastic tube
JournalofPediatric Surgery, Vol 27, No 5 (May), 1992: pp 650-651
PLEASE
SUPPLY
651
WORDING
during insertion is prevented by passing it through a more rigid Nelaton catheter, which is peeled away at the end of the procedure. This procedure is easy to perform, not time consuming, sterility breakage is avoided, and lacks complica-
tions. Introducing a feeding tube into the stomach will enable enteral feeding and prevent possible complications of gastrostomy, including a higher percentage of gastroesophageal reflux.’
REFERENCES 1. Randolph JG: Esophageal atresia and congenital stenosis, in Welch KJ, Randolph JG, Ravitch MM, et al (eds): Pediatric Surgery (ed 4). Chicago, IL, Year Book, 1986, pp 682-697
2. Canal DF, Vane D, Goto S, et al: Reduction of lower esophageal sphincter pressure with Stanison gastrostomy. J Pediatr Surg 2254-57, 1987
of a Soft Silastic Nasogastric Tube at Operation Esophageal Atresia: A New Technical Method ByY.Sweed,
J.A. Bar-Maor, Haifa,
for
and G. Shoshany
Israel
l A new and simple technical method for insertion of a soft silastic nasogastric tube into the stomach in neonates born with esophageal atresia is described. The technique is simple, easy to perform, and enables feeding the baby through this tube a day after the operation. Our method is based on the principle used in insertion of Broviac-Hickman catheters, namely the use of a “peel-away sheath” through which the silastic feeding tube is threaded. We have used this technique in five patients with esophageal atresia without any complication. Copyright Q 1992 by W.B. Saunders Company INDEX WORDS:
Esophageal atresia.
E
NTERAL FEEDING is superior to intravenous alimentation. It is more physiological and is almost without complications. To achieve this goal after repair of esophageal atresia, many pediatric surgeons perform a gastrostomy.’ Others will pass a soft nasogastric feeding tube through the esophageal anastomosis into the stomach at the time of the operation. The usual technique for the passage of the feeding tube through the nose into the stomach is not without complications, not to mention sterility breakage.
MATERIALS
AND METHODS
After performing half of the anastomosis (posterior wall) between the upper and lower segments of the esophagus, a soft and sterile feeding tube (5F) is introduced into a Nelaton catheter (12F). in which its proximal 2 cm were cut off (Fig 1). The combined feeding tube and the Nelaton catheter is then passed aseptically through the nose of the baby by the anaesthetist to the level of the uncompleted anastomosis (Figs 1A and 1B). Once the tip of the Nelaton catheter is visible in the anastomosis, its end is cleaned by iodine solution and pulled out for about 2 cm. Next the rounded end of the Nelaton catheter is cut off while taking care to prevent any damage to the tip of the feeding tube (Fig 1C).
From the Department of Pediatric Surgety~ Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Date accepted: February 22, 1991. Address reprint requests to Professor J.A. Bar-Maor, MD, FACS, FAAP, Chief Department of Pediatric Surgery Rambam Medical Center, Haifa 31096, Israel. Copyright o 1992 by W.B. Saunders Company 0022-3468/9212705-0029$03.OOiO
650
Fig 1. (A and B) The silastic feeding tube, inside the Nelaton catheter is passed through the nose to the region of the anastomosis. (C)The rounded end of the Nelaton catheter is cut off. (D) The feeding tube is pushed forward by the anesthetist and grasped by an anatomical forceps. (E) Pulling out the Nelaton catheter while the surgeon holds the feeding tube in place. (F) The silastic feeding tube in place. (G) Peeling off the Nelaton catheter from the feeding tube.
The feeding tube is pushed forward by the anesthetist for 1 cm and grasped by the surgeon with an anatomical forceps. It is pulled into the anastomosis for a few centimeters and simultaneously pushed into the stomach through the distal esophagus. The Nelaton catheter is then withdrawn by the anesthetist while the surgeon secures the feeding tube in place (Fig 1E) (care must be taken not to displace the endotracheal tube at all stages of the passage of the feeding tube). Closure of the anterior wall of the esophagus completes the procedure (Fig 1F). At the end of the operation the surgeon opens longitudinally the Nelaton catheter by scissors and it is peeled away from the feeding tube (Fig 1G); the “peeling away” is necessary to preserve the proximal end of the silastic tube, which is wider than the Nelaton catheter, due to the presence of its connecting hub. The feeding tube is then fixed properly to the baby’s face. DISCUSSION
A technical method is described, by which a soft silastic feeding tube is passed through the esophagoesophageal anastomosis and into the stomach in cases of esophageal atresia. Coiling of the soft silastic tube
JournalofPediatric Surgery, Vol 27, No 5 (May), 1992: pp 650-651
PLEASE
SUPPLY
651
WORDING
during insertion is prevented by passing it through a more rigid Nelaton catheter, which is peeled away at the end of the procedure. This procedure is easy to perform, not time consuming, sterility breakage is avoided, and lacks complica-
tions. Introducing a feeding tube into the stomach will enable enteral feeding and prevent possible complications of gastrostomy, including a higher percentage of gastroesophageal reflux.’
REFERENCES 1. Randolph JG: Esophageal atresia and congenital stenosis, in Welch KJ, Randolph JG, Ravitch MM, et al (eds): Pediatric Surgery (ed 4). Chicago, IL, Year Book, 1986, pp 682-697
2. Canal DF, Vane D, Goto S, et al: Reduction of lower esophageal sphincter pressure with Stanison gastrostomy. J Pediatr Surg 2254-57, 1987
