The role of surgical gastrostomy in the age of endoscopic gastrostomy: a 13 years and 543 patients retrospective study

Abstract

Background: Percutaneous endoscopic gastrostomy (PEG) became the gold standard for enteral feeding. Currently, surgical gastrostomy is seldom used.Objective: Evaluating the role of surgical gastrostomy in a center with a large experience in PEG.Methods: A retrospective study ranged 13 years, collecting from clinical records: age, gender, underlying disease, date of procedure, technique, primary surgery, complications, 30-day mortality. Patients were divided according to indication for gastrostomy: a) neurological; b) head and neck cancer; c) other diseases; and d) drainage. PEG, open surgical and laparoscopic gastrostomies were compared concerning evolution of the number of procedures, characteristics of patients, complications and mortality.Results: We identified 509 PEG, 26 open and 8 laparoscopic surgical gastrostomies. An increasing number of the percutaneous approach over the years was observed, while the number of surgical gastrostomies remains steady (mean: 2.6/year). All percutaneous endoscopic gastrostomies but three were feeding procedures, mostly in neurological patients. All laparoscopic gastrostomies were feeding procedures in head and neck cancer. Most open surgical gastrostomies were secondary procedures, part of more complex surgeries, and frequently for drainage purposes. The open surgical approach displayed more morbidity and mortality, reflecting the severity of underlying diseases.Conclusions: In our institution, open surgical gastrostomy is seldom used, and mostly as part of complex procedures, frequently for drainage purposes. PEG is the choice to most dysphagic patients needing an enteral feeding access. When not feasible, laparoscopic gastrostomy is a suitable alternative.

Surgical Gastrostomy With Mini Laparatomy Under Local Anesthesia: Analysis of 62 Cases

“…ESPEN (The European Society for Clinical Nutrition and Metabolism) suggests PEG in such patients for feeding if it will be continued more than 2 to 3 weeks (11). PEG was found superior to SG because of both its low cost and complication and low mortality rates by the studies conducted in last 20 years (12,13). In presence of obstructing tumours in head, neck or upper GIS, presence of neuromuscular disorders which necessitate continuous non-invasive ventilator use and in situations where stomach is cannot be accessed endoscopically, surgical or radiologic techniques come into mind to place a feeding tube (7).…”

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

“…Studies comparing SG with PEG have shown no differences in morbidity and mortality rates; nevertheless, PEG is less expensive and is easier and faster to perform [49]. SG is commonly reserved for patients who will undergo another surgical procedure or in a setting in which PEG and RIG are contraindicated or not locally available [49,50].…”

Clinical Features and Advantages of a Novel Percutaneous Endoscopic Gastrostomy Method

“…The catheter outlet of the gastric wall was also sutured and fixed with the peritoneum. The incision was sutured layer by layer and covered with sterile gauze for fixation [11].…”