Gastrostomy
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Gastrostomy is a surgical opening made in the stomach to allow for placement of a feeding tube. It is indicated for patients who require prolonged tube feeding for over 4 weeks due to conditions such as neurological swallowing disorders, esophageal cancer, or gastric outlet obstruction. There are two main types - open gastrostomy involving surgical incision and percutaneous endoscopic gastrostomy (PEG) which is performed endoscopically. Complications can include infection, hemorrhage, leakage or displacement of the tube. Gastrostomy allows for safe enteral feeding in patients with poor oral intake who have a functional gastrointestinal system.
![References
• http://emedicine.medscape.com/article/149665-overview#a2. Retrieved on the 2nd
March, 2016
• Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced
dementia.Cochrane Database Syst Rev. 2009;(2):CD007209. [PubMed]
• Kimyagarov S, Turgeman D, Fleissig Y, Klid R, Kopel B, Adunsky A. Percutaneous
endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not
associated with improved body composition parameters. J Nutr Health
Aging. 2013;17:162–165. [PubMed]](https://image.slidesharecdn.com/gastrostomy-160311100952/85/Gastrostomy-15-320.jpg)
Gastrostomy
- 2. OUTLINE • Definition • Indications for gastrostomy • Contraindications • Types of gastrostomy • Procedure • Post op • Summary • References
- 3. What is Gastrostomy? • An opening in the stomach made surgically, usually connecting the stomach to the outside of the abdomen so that a feeding tube or gut decompression tube can be passed into the stomach.
- 4. Indications for gastrostomy • Neurological swallowing disorders e.g cerebral palsy, multiple sclerosis etc • Esophageal stricture or atresia • Esophageal cancer • Gastric outlet or small bowel obstruction • Major neck surgeries • Any condition which requires prolonged tube feeding for > 4weeks.
- 5. Contraindications • Uncorrectable coagulopathy or thrombocytopenia • Active gastritis or peptic ulcer disease • History of total gastrectomy • Severe ascites • Active peritonitis
- 6. Types Open gastrostomy • Stamm’s • Janeway’s Percutaneous endoscopic gastrostomy(PEG)
- 7. Procedure Open gastrostomy; There are many types of open gastrostomy but the commonly used types are the Stamm and Janeway gastrostomy • Preoperatively; baseline investigations, plain abd.xray, upper G.I endoscopy, NPO, consent • Anaesthesia; local, general • Positioned and Skin prep
- 8. • Incision; small upper midline, left subcostal • The peritoneal cavity is entered and the anterior wall of the stomach is grasp with two pairs of Babcock forceps and the stomach drawn unto the surface. The stomach is incised to allow insertion of a 12 or 14Fr forley catheter whose balloon is then inflated. Leakage along side the catheter is prevented in one of two ways; Stamm’s or Janeway’s.
- 9. • Stamm’s method; two purses string suture of non- absorbable material are inserted concentrically around the tube, the 1st 1cm from the tube. This is then inverted by a second concentric suture 2cm from the tube. When drawn tight, these suture invaginate the catheter. • Janeway’s method; a valve is created by burying the tube in a short tunnel in the stomach wall. The tube is brought out through a stab incision on the anterior abdominal wall. To further prevent leakage, the anterior gastric wall is sutured to the parietal peritoneum at the region of the tube. With interrupted sutures.
- 11. Percutaneous endoscopic gastrostomy • Reduced morbidity and mortality compared to open. • The fiber optic endoscope is passed into the stomach and directed towards the anterior abdominal wall. • The second operator identify it by transillumination and guide it to the ideal site of placement of the tube. • A cannula is passed by the abdominal operator percutaneously into the stomach, he then pass a thread through the cannula. • This thread is grasped under direct vision by the endoscopist using biopsy forceps and drawn back through the mouth. • The gastrostomy tube is securely anchored to the thread which is pulled by the abdominal operator delivering it through the mouth, esophagus, stomach and through the anterior abdominal wall. • The tube secured on the skin with nylon
- 13. Post Op. Feeding is usually after 24hours. When bowel sounds are heard. Patient is taught how to care for the tube and to recognize infection. Complications; Infection Trauma to other structures eg colon Hemorrhage Leakage Blockage Aspiration pneumonia Displacement of tube
- 14. Conclusion • Since its introduction, gastrostomy has gained world-wide acceptance as a safe technique for providing enteral feeding in patients with poor oral intake who have a functional GI system.
- 15. References • http://emedicine.medscape.com/article/149665-overview#a2. Retrieved on the 2nd March, 2016 • Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia.Cochrane Database Syst Rev. 2009;(2):CD007209. [PubMed] • Kimyagarov S, Turgeman D, Fleissig Y, Klid R, Kopel B, Adunsky A. Percutaneous endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not associated with improved body composition parameters. J Nutr Health Aging. 2013;17:162–165. [PubMed]