What is Triple Tube Drainage and When to Use It
Triple tube drainage is a specialized technique involving placement of three separate tubes (typically for abscess drainage, jejunal decompression, and enteral nutrition) used primarily for managing esophagojejunal anastomotic fistulas after gastrectomy, though the term is not a standard designation in mainstream surgical practice. 1
Definition and Components
The "triple-cavity drainage tube" or "three-tube method" consists of:
- Abscess drainage catheter - for evacuating infected fluid collections 1
- Jejunal decompression tube - for reducing pressure at the anastomotic site 1
- Jejunal nutrition tube - for maintaining enteral feeding distal to the fistula 1
This configuration can be achieved either through three separate transnasal tubes placed under fluoroscopic guidance, or via a single homemade triple-cavity drainage tube placed by guide wire exchange method for continuous irrigation and negative pressure suction near the fistula site. 1
Clinical Indications
Primary Indication: Esophagojejunal Anastomotic Fistula
The triple tube drainage technique is specifically indicated for esophagojejunal anastomotic fistulas following gastrectomy when conservative management with single-drain approaches has failed or when complex fistula management requiring simultaneous drainage, decompression, and nutrition is needed. 1
The procedure allows for:
- Adequate drainage of the fistula and associated abscess 1
- Decompression to reduce pressure on the anastomotic site 1
- Maintenance of nutritional support during healing 1
- Continuous irrigation with negative pressure suction 1
Important Caveats
Not Standard Terminology
This is NOT a widely recognized or standardized term in general thoracic or abdominal surgery guidelines. The available evidence consists of a single case report/technical note from 2023, not established guidelines from major surgical societies. 1
Standard Drainage Principles Apply
For routine surgical drainage needs, established principles should guide practice:
Peritoneal drainage after colonic anastomosis is NOT routinely recommended - meta-analyses of 8 RCTs with ≥1390 participants showed no benefit for clinical or radiological anastomotic dehiscence, wound infection, re-operation, or mortality 2
Single chest tube drainage remains the standard for pleural infections, with small-bore drains (≤14F) preferred over large-bore tubes for patient comfort without compromising efficacy 2, 3
Source control for intra-abdominal infections should focus on definitive surgical management (resection, debridement, repair) rather than complex multi-tube drainage systems 2
When Multiple Drains May Be Appropriate
Multiple drainage tubes may be justified when:
- Loculated collections require drainage from separate compartments 2, 4
- Planned re-laparotomy strategies for severe peritonitis necessitate ongoing drainage 2
- Complex fistulas require simultaneous drainage, decompression, and nutritional access 1
Practical Approach
For esophagojejunal anastomotic fistulas specifically: Consider the triple tube technique as a minimally invasive bedside option that can be performed without anesthesia, providing adequate drainage while allowing fistula self-healing. 1
For all other surgical drainage scenarios: Follow established single-drain principles with small-bore tubes placed under image guidance (ultrasound or CT), using closed-suction systems, and removing drains as early as safely possible. 2, 3, 5