Soft tissue-anchored transcutaneous port attached to an intestinal tube for long-term gastroduodenal infusion of levodopa/carbidopa in Parkinson disease.

PURPOSE

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.

MATERIALS AND 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.