Gastrostomy Explained

Gastrostomy

A gastrostomy is the creation of an artificial external opening into the stomach for nutritional support or gastric decompression.Typically this would include an incision in the patient's epigastrium as part of a formal operation. When originally devised over a century ago the procedure was completed through open surgery using the Stamm technique.[1] It can be performed through surgical approach, percutaneous approach by interventional radiology, percutaneous endoscopic gastrostomy (PEG) or percutaneous ultrasound gastrostomy (PUG).[2]

A gastrostomy may be required due to illness, trauma or disability impacting upon the ability to eat or swallow safely, or conditions causing increased nutritional requirement [3] and once formed (or for some techniques, during formation), a gastrostomy tube is inserted.

Techniques

The Stamm gastrostomy is an open technique,[4] requiring an upper midline laparotomy and gastrotomy, with the catheter brought out in the left hypochondrium. It was first devised in 1894 by the American Gastric Surgeon, Martin Stamm (1847–1918), who was educated greatly in surgery when he visited Germany.[5]

Over the last three decades less invasive approaches such as percutaneous endoscopic gastrostomy (PEG) and laparoscopic assisted Stamm gastrostomy[6] have become increasingly popular.[7] [8] [9]

Conventional PEG involves inserting the primary feeding device through the mouth and extracting it through a small incision formed through the abdomen.[10]

Apparent benefits of PEG include shorter operative times and reduced financial cost.[11] [12] [13]

Complications

Severe complications for gastrostomy formation classify as Clavien-Dindo grade 3 and above, requiring surgical or radiological interventions with potential morbidity and mortality.[14] [15] These complications may occur due to damage to surrounding structures intra-operatively, issues affecting the immature gastrostomy early post-operatively, or be secondary to device or site complications, including: adjacent bowel injury, gastrocolic fistulae, migration of gastrostomy to ribs, and failure for spontaneous closure when gastrostomy no longer needed (persistent gastrocutaneous fistula).[16]

See also

Notes and References

  1. Souza . Emmanuel Conrado . Surgical Gastrostomy Based on Endoscopic Concepts . 2016 . Arquivos Brasileiros de Cirurgia Digestiva . 29 . 1 . 50–52 . 10.1590/0102-6720201600010013 . 27120741 . 4851152 .
  2. Gentry Wilkerson. R.. Pustavoitau. Aliaksei. Carolan. Howard. Benner. Nolan. Fischer. Clark. Sheets. Daniel J.. Wang. Peggy I.. Tropello. Steven. 2019-06-01. Percutaneous Ultrasound Gastrostomy: A Novel Device and Bedside Procedure for Gastrostomy Tube Insertion Using Magnetic and Ultrasound Guidance. Journal of Medical Devices. en. 13. 2. 024501. 10.1115/1.4042866. 115288545. 1932-6181.
  3. Braegger . Christian . Decsi . Tamas . Dias . Jorge Amil . Hartman . Corina . Kolacek . Sanja . Koletzko . Berthold . Koletzko . Sibylle . Mihatsch . Walter . Moreno . Luis . Puntis . John . Shamir . Raanan . Szajewska . Hania . Turck . Dominique . van Goudoever . Johannes . ESPGHAN Committee on Nutrition . July 2010 . Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition . Journal of Pediatric Gastroenterology and Nutrition . 51 . 1 . 110–122 . 10.1097/MPG.0b013e3181d336d2 . 1536-4801 . 20453670. free .
  4. P C Shellito . R A Malt . 1985 . Tube gastrostomy. Techniques and complications . Annals of Surgery . 201 . 2 . 180–185 . 10.1097/00000658-198502000-00008. 1250638 . 3918515.
  5. [:de:Martin Stamm]
  6. Kaya . Mete . Sancar . Serpil . Ozcakir . Esra . January 2018 . A New Method for Laparoscopic Stamm Gastrostomy . Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A . 28 . 1 . 111–115 . 10.1089/lap.2017.0447 . 1557-9034 . 29227195.
  7. Rothenberg . S. S. . Bealer . J. F. . Chang . J. H. . October 1999 . Primary laparoscopic placement of gastrostomy buttons for feeding tubes. A safer and simpler technique . Surgical Endoscopy . 13 . 10 . 995–997 . 10.1007/s004649901154 . 0930-2794 . 10526034. 11945156 .
  8. Georgeson . K. E. . 1998-03-01 . Laparoscopic Fundoplication and Gastrostomy . Surgical Innovation . en . 5 . 1 . 25–30 . 10.1177/155335069800500106 . 9516557 . 1468213 . 1553-3506.
  9. Gauderer . M. W. . Ponsky . J. L. . Izant . R. J. . December 1980 . Gastrostomy without laparotomy: a percutaneous endoscopic technique . Journal of Pediatric Surgery . 15 . 6 . 872–875 . 10.1016/s0022-3468(80)80296-x . 0022-3468 . 6780678.
  10. Gauderer . M. W. . Ponsky . J. L. . Izant . R. J. . December 1980 . Gastrostomy without laparotomy: a percutaneous endoscopic technique . Journal of Pediatric Surgery . 15 . 6 . 872–875 . 10.1016/s0022-3468(80)80296-x . 0022-3468 . 6780678.
  11. Baker . Laura . Beres . Alana L. . Baird . Robert . May 2015 . A systematic review and meta-analysis of gastrostomy insertion techniques in children . Journal of Pediatric Surgery . 50 . 5 . 718–725 . 10.1016/j.jpedsurg.2015.02.021 . 1531-5037 . 25783383. 21084418 .
  12. Fortunato . John E. . Troy . April L. . Cuffari . Carmen . Davis . J. Erin . Loza . Matthew J. . Oliva-Hemker . Maria . Schwarz . Kathleen B. . April 2010 . Outcome after percutaneous endoscopic gastrostomy in children and young adults . Journal of Pediatric Gastroenterology and Nutrition . 50 . 4 . 390–393 . 10.1097/MPG.0b013e3181aed6f1 . 1536-4801 . 20179645. 25724743 . free .
  13. Lee . Hanmin . Jones . Angela . Vasudevan . Sanjeev . Wulkan . Mark L. . 2002-03-01 . Evaluation of Laparoscopy-Assisted Percutaneous Gastrostomy Tube Placement in Children . Pediatric Endosurgery & Innovative Techniques . 6 . 1 . 29–32 . 10.1089/10926410252832429 . 1092-6410.
  14. Sandberg . Filip . Viktorsdóttir . Margrét Brands . Salö . Martin . Stenström . Pernilla . Arnbjörnsson . Einar . December 2018 . Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis . Pediatric Surgery International . 34 . 12 . 1321–1327 . 10.1007/s00383-018-4358-6 . 1437-9813 . 6244983 . 30291404.
  15. Dindo . Daniel . Demartines . Nicolas . Clavien . Pierre-Alain . August 2004 . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey . Annals of Surgery . 240 . 2 . 205–213 . 10.1097/01.sla.0000133083.54934.ae . 0003-4932 . 1360123 . 15273542.
  16. St-Louis . Etienne . Safa . Nadia . Guadagno . Elena . Baird . Robert . May 2018 . Gastrocutaneous fistulae in children - A systematic review and meta-analysis of epidemiology and treatment options . Journal of Pediatric Surgery . 53 . 5 . 946–958 . 10.1016/j.jpedsurg.2018.02.022 . 1531-5037 . 29506816.

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