Use of the monti principle for constructing a continent gastrostomy

Abstract

Objective: To research technical alternatives for permanent gastrostomy that minimizes the drawbacks and complications reported by several authors.Materials and Methods: An experimental model was developed where the material was divided into 2 groups: the study group (SG) composed of 12 half-breed dogs where the proposed technique was applied, and the control group (CG) composed of 10 animals where a gastrostomy as proposed by Webster in 1974 was applied. On the 90th postoperative day, both groups underwent tests for assessing competence concerning leakage. These were performed under general anesthesia and following sacrifice.Results: In the SG, under anesthesia only one animal had leakage through the gastrostomy. Following sacrifice, leakage was observed in 2 animals. In the CG, under anesthesia, 2 animals had leakage and, following sacrifice, only 1 animal did not present leakage. On histopathological analysis of the SG, gastric mucosa was evidenced around the jejunal tubes, with normal features, moderate inflammatory mononuclear infiltrate in jejunal tubes and only slight infiltrate around the gastrostomy stoma. In the CG, ulceration was constant around the external stoma of the gastrostomy tubes. In the corium, the inflammatory infiltrate was less intense than in the SG. The SG proved to be more efficacious than the CG concerning leakage, and this efficacy is attributed to the submucous valvular system.Conclusions: The featured technique showed competence concerning leakage, allowing its clinical applicability as an alternative for permanent gastrostomy.

A novel technique of permanent self-catheterizable feeding jejunostomy

“…The Monti tube principle is well known and successfully used in urologic surgery to create catheterizable urinary diversion conduits and for bowel management washouts [7]. The same principle has also been used in animals to construct a permanent gastrostomy with satisfactory results [8]. Our technique uses this principle to create a long pedicled tube from a small segment of jejunum and achieves continence by creation of a submucosal tunnel.…”

Reconstrução da via biliar com tubo de segmento jejunal

“…O procedimento original de Monti vem sendo usado em humanos com sucesso principalmente na construção de conduto eferente cateterizável em derivações urinárias cutâneas continentes. Tal princípio também foi aplicado com finalidades diversas, a saber: na confecção de gastrostomias continentes, permitindo ao paciente a sondagem intermitente para introdução dos alimentos no estômago, sem vazamentos ao retirar-se a sonda (Araujo et al, 2005); na construção de neovagina em crianças com intersexo (Freitas Filho et al, 2001;Arap e Monti, 2006); na substituição parcial ou total de ureteres (Ghoneim, 2006) O propósito desta pesquisa é desenvolver um modelo experimental de derivação biliodigestiva pela técnica de interposição colédoco-duodenal de um tubo de segmento jejunal, segundo o princípio de Monti, e avaliar a sua eficácia na desobstrução mecânica da via biliar.…”