Transgastric drainage of the oesophagus: managing difficult oesophageal injuries

We describe a technique for maintaining patency of the injured or repaired oesophagus while providing vacuum drainage of the oesophageal lumen. A small midline laparotomy is performed. A lubricated 36F soft chest drain (pull-through end) is introduced into the oesophagus using a percutaneous endoscopic gastrostomy (PEG) set, and pulled out through the stomach wall. The drain is brought out through the abdominal wall and the stomach is anchored to the peritoneum. The transgastric drain is positioned across the oesophageal defect. A feeding jejunostomy is placed. Decontamination and drainage of the chest is performed if the patient's condition allows. The patient takes sterile water by mouth to maintain drain patency, with -10 cm H(2)O suction applied. We have used this drainage procedure in seven patients (Boerhaave's syndrome (n=4), operative injury (n=3)). In five patients with injuries close to the oesophagogastric junction, this method was used as an adjunct to primary repair. There were no deaths; the oesophageal defect healed in all patients without stricture. All patients are swallowing normally at follow-up. This procedure is presented as an option for patients who are unfit for primary repair, or whose primary repair would benefit from efficient drainage and protection.