Gastrostomy feeding (temporary)

Operative procedure for temporary gastrostomy feeding

1. Gastrostomy feeding Hendy Buana Vijaya

2. Indication Gastorstomy feeding indication : obstruction of the esophagus , most frequently employed as a palliative procedure in nonresectable lesions prolonged nasogastric suction, (temporary procedure) following such major abdominal procedures as vagotomy and subtotal gastrectomy, colectomy, and so forth. (Considered) during abdominal operation in those poor-risk or elderly patients prone to pulmonary difficulties or where postoperative nutritional difficulties are anticipated As a temporary gastrostomy , the Witzel or the Stamm procedure is used frequently and is easily performed. A permanent type of gastrostomy , such as the Janeway and its variations, is best adapted to patients in whom it is essential to have an opening into the stomach for a prolonged period of time

3. Stamm Gastrostomy Procedure A small incision is made, upper midline incision, which may be extended, if necessary. The usual temporary tube gastrostomy is brought out through a stab wound some distance from the primary incision and away from the costal margin. The mid anterior gastric wall is grasped with a Babcock forceps, approximately 6–10 cm from the gastroduodenal junction A purse-string suture using 3-0 silk or VI cryl ( nonabsorbable ) suture is placed in the mid anterior wall of the stomach

4. Procedure Make a very small stab incision (usually 0.5 cm in length) in the center of the designated area of the purse-string sutures and insert an 18–22 Foley balloon catheter Check the balloon, insert the catheter and inflate the balloon. Tie the inner purse string very tightly, then tie the outer purse string; do not cut it or remove the needles .

5. Procedure Pull the catheter until it reaches the gastric mucosa at the gastric stab wound. Stitch the purse-string sutures to the anterior abdominal wall. To make certain that dead space does not exist , use a third 3-0 silk suture to fix the gastric wall to the anterior abdominal wall.

6. Procedure Close the skin and use a 2-0 silk suture to secure the gastrostomy tube to the skin of the abdominal wall

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