Securing Feeding Tubes in Head and Neck Surgery: Septal Suture or Bridle Technique

Results Discussion References Securing Feeding Tubes in Head and Neck Surgery: Septal Suture or Bridle Technique Samer Al-Khudari1 MD, Daniel Clayburgh2 MD PhD, Lisa Morris2 MD, Tammara Watts2 MD PhD, Mark K. Wax2 MD, Tamer A. Ghanem1 MD PhD 1Department of Otolaryngology-Head & Neck Surgery Henry Ford Health System, Detroit, Michigan 2Departmet of Otolaryngology –Head & Neck Surgery Oregon Health & Science University, Portland, Oregon Objectives: To compare use of the anterior septal suture (SS) technique versus the septal bridle technique (BT) in securing nasogastric feeding tubes in head and neck surgery patients. Study Design: A multicenter prospective nonrandomized controlled study was conducted on patients undergoing head and neck surgery with postoperative need for a nasogastric feeding tube. Methods: Patients underwent either a septal suture or a bridle technique to secure the feeding tube intraoperatively. They were assessed by a standard questionnaire and physical exam administered at three time points postoperatively: days 1-5 (time-1), 6-9 (time-2), and day 10 or greater (time-3). The following factors were assessed: subjective assessment of overall pain, pain due to securing mechanism, route of pain control, local complications, and tube dislodgement secondary to securing method. To analyze pain at each time point a nonparametric two sample Wilcoxon test was used. To analyze the change in pain from time 1 to time 2 a Wilcoxon matched pairs signed rank test was used. Results: 74 patients were enrolled in the study. 29 patients underwent a septal suture technique and 45 underwent the bridle technique. No local complications were reported secondary to either securing method. No tube dislodgments occurred directly as a result of either securing technique. Overall pain did not significantly differ in both cohorts at each time point (p=0.196, 0.808, 0.469). Pain due to the tube securing method was significantly less for the bridle technique at time points 1 and 2 but not at time 3 (p=0.037, 0.021, 0.722). Overall pain and pain due to securing method did not significantly differ in patients primarily controlled on PO or IV medication at time 1 (p=0.744, p=0.909). When analyzing the change in overall pain from time 1 to time 2 in both cohorts there was a significant decrease in pain (p=0.001, p=0.001). When analyzing the change in mean pain due to the securing mechanism from time 1 to time 2 it was found to be significant in the SS patients (p=0.036) and approaching significance in the BT patients (p=0.078). Conclusions: The septal suture and bridle technique are both effective methods in securing feeding tubes postoperatively in head and neck surgery patients. In both cohorts no local complications were directly attributed to securing method and no tube dislodgments were reported directly related to the securing method.