Gastrostomy for enteral access

Abstract

Gastrostomy can be performed safely by all three techniques, with similar outcomes. PEG is our method of choice. Lap GT is preferred in patients with head and neck carcinoma, patients with obstructing esophageal carcinoma, and patients who have problems with overlying liver or colon. Open GT is reserved for cases with extensive intraabdominal adhesions or those where the procedure is done during an ongoing laparotomy.

Comparison of Laparoscopic Versus Open Approach to Gastrostomy Tubes

“…Furthermore, the main indications for surgery were trauma and burn, which may have influenced outcomes, especially those related to respiratory or surgical site infection. 9 A higher postoperative complication rate using laparoscopy (7.7%) versus open (0%) was found in a study published by Bankhead et al Complications in the laparoscopic group included 1 episode each of cellulitis, bleeding, and serous drainage around the tube, all attributed to the use of T-fasteners. His study excluded patients who had prior upper abdominal surgery and focused more on nutritional outcomes and complications.…”

“…15 The study included only head and neck or esophageal cancer patients, of which only 2 were noted to have had prior gastric surgery. These studies were followed by comparative studies showing similar results when compared with the standard Stamm gastrostomy and PEG techniques, 6,9 with others showing even fewer complication with the open approach. 5 …”

“…Other studies using different techniques have shown tube dislodgment rates of up to 14%. 8,9 We attribute our relatively low rate of tube dislodgment to the double purse-string suture and seromuscular sutures placed intracorporeally, further reinforcing the tube to the stomach and the stomach to the anterior abdominal wall.…”

“…6,9 The 2 patients who died, one from sepsis and the other from acute respiratory distress syndrome, were 84 and 90 years old, respectively. They both had major comorbidities such as coronary artery disease, chronic obstructive pulmonary disease, hypertension, and dementia.…”

“…The stomach was anchored to the anterior abdominal wall either with T-fasteners or with regular sutures. 5–9 When compared with the standard open GT, it showed decreased operative time and equal cost. 5,7 Nevertheless, this approach may prove difficult when adhesions are present, causing challenging stomach mobilization in patients with prior upper abdominal surgery.…”