Fixation of Celestin tube to the anterior abdominal wall. A new technique.

Palliative intubation in the management of an unresectable carcinoma of the esophagus can be accomplished by "push through" or "pull through" techniques. The most frequently encountered complication is tube dislodgment-proximal or distal migration. Dislodgment occurs more freqeuntly with the "push through" tubes such as the Souttar tube than with the "pull through" tubes such as the Celestin tube. The incidence of migration reported for the "pull through" tubes varies from 3 to 14 per cent. In order to prevent migration, we sutured the tube to the anterior abdominal wall in 6 patients. The sixth patient developed a gastrocutaneous fistula and fasciitis at the point of anterior abdominal wall fixation. In the next 4 cases, we used a two-suture technique, in which no single suture passed from the gastric lumen to the anterior abdominal wall fascia. The Celestin tube was fixed to the gastric wall over a Dacron felt pledget and this pledget was then anchored to the rectus fascia. This technique has prevented both migration of the tube and complications related to gastric perforation.