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
In anatomy, the epigastrium (or epigastric region) is the upper central region of the abdomen. It is located between the costal margins and the subcostal plane. Pain may be referred to the epigastrium from damage to structures derived from the for ...
as part of a formal operation. When originally devised over a century ago the procedure was completed through open surgery using the Stamm technique. It can be performed through surgical approach,
percutaneous approach by
interventional radiology
Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as Fluoroscopy, x-ray fluoroscopy, CT scan, computed tomography, magnetic resonance imaging, or ultraso ...
,
percutaneous endoscopic gastrostomy (PEG) or
percutaneous ultrasound gastrostomy (PUG).
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 and once formed (or for some techniques, during formation), a
gastrostomy tube is inserted.
Techniques
The Stamm gastrostomy is an open technique, requiring an upper midline
laparotomy
A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy.
Origins and history
The first successful laparotomy was performed without ...
and gastrotomy, with the catheter brought out in the left
hypochondrium
In anatomy, the division of the abdomen into regions can employ a nine-region scheme. The hypochondrium refers to the two hypochondriac regions in the upper third of the abdomen; the left hypochondrium and right hypochondrium. They are located ...
. 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.
Over the last three decades less invasive approaches such as percutaneous endoscopic gastrostomy (PEG) and laparoscopic assisted Stamm gastrostomy have become increasingly popular.
Conventional PEG involves inserting the primary feeding device through the mouth and extracting it through a small incision formed through the abdomen.
Apparent benefits of PEG include shorter operative times and reduced financial cost.
Complications
Severe complications for gastrostomy formation classify as Clavien-Dindo grade 3 and above, requiring surgical or radiological interventions with potential morbidity and mortality. 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).
See also
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Enteral feeding
A feeding tube is a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state of being fed by a feeding tube is called gavage, enteral fee ...
*
List of surgeries by type
Many Surgery, surgical procedure names can be broken into parts to indicate the meaning. For example, in gastrectomy, "ectomy" is a suffix (linguistics), suffix meaning the removal of a part of the body. "Gastro-" means stomach. Thus, ''gastrectom ...
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Stoma (medicine)
References
{{Digestive system surgical procedures
Enteral feeding
Digestive system procedures