LARYNGECTOMY FAQ'S

We know a PEG tube is often used for a throat cancer patient during healing or while having difficulty swallowing.  We would like some insight into three problems:
(by Glenn E. Peters M.D., Director, Division of Otolaryngology
Head and Neck Surgery, University of Alabama at Birmingham,
Birmingham, Alabama, USA)

1.   If, over a period of a couple of years, a patient has repeated dilations, manages soft food occasionally, but is on mostly a liquid diet, what are the choices to be able to eat again?
2.   When leakage occurs, is there a good way to stop it or a product to put on the skin to avoid excess irritation?
3.   When you are eating easily and it is time to remove the PEG tube, are there complications involved in the healing after removal of the PEG s?  If it doesn't close up properly, where do you go from there?

OK ... Let's talk PEG Tubes:

1.   The first question concerns a chronic problem with difficulty swallowing, despite repeated dilations.  Let me give you my opinion about dilation.  Basically, I don't think it works.  Let's look at the problem.  You have a round organ such as the esophagus.  Around this circular organ you have scar tissue.  The most basic thing that scar tissue does is to CONTRACT.  When you have contracture around a circular organ you get narrowing or stricture.  Now, let's look at what happens when you dilate something.  What you do is forcibly break up the scar causing a new wound.  This results in guess what?  That's right, more scar tissue.  And what is scar going to do?  CONTRACT!!  Therefore you have set up a viciously cycle of scar, contracture, more scar, and more contracture. Hence, no improvement.  It is my feeling that to truly improve the situation, you have to bring in new tissue that is not affected by this cycle.

2.   When leakage occurs around a PEG tube it is always best to make sure that the tube is tight against the body wall.  Make sure the bumper or balloon inside the stomach is working properly and the outer flange can be snugged up to the skin.  Not too tight, but just right.  A single layer of gauze is usually enough to catch any drainage.

3.   Generally, PEG tubes can be removed in the office and the wound will close on its own in 2 to 3 days.  It is very rare for the fistula (ya'll remember what a fistula is?) not to close, but if it doesn't, it is a matter of a limited out-patient surgery to rectify the situation.