Gastrostomy is a surgical opening made in the stomach to allow for placement of a feeding tube. It is indicated for patients who require prolonged tube feeding for over 4 weeks due to conditions such as neurological swallowing disorders, esophageal cancer, or gastric outlet obstruction. There are two main types - open gastrostomy involving surgical incision and percutaneous endoscopic gastrostomy (PEG) which is performed endoscopically. Complications can include infection, hemorrhage, leakage or displacement of the tube. Gastrostomy allows for safe enteral feeding in patients with poor oral intake who have a functional gastrointestinal system.

1. GASTROSTOMY
By
Aniedu, Ugochukwu

2. OUTLINE
• Definition
• Indications for gastrostomy
• Contraindications
• Types of gastrostomy
• Procedure
• Post op
• Summary
• References

3. What is Gastrostomy?
• An opening in the stomach made surgically, usually
connecting the stomach to the outside of the abdomen
so that a feeding tube or gut decompression tube can
be passed into the stomach.

4. Indications for gastrostomy
• Neurological swallowing disorders e.g
cerebral palsy, multiple sclerosis etc
• Esophageal stricture or atresia
• Esophageal cancer
• Gastric outlet or small bowel obstruction
• Major neck surgeries
• Any condition which requires prolonged tube
feeding for > 4weeks.

5. Contraindications
• Uncorrectable coagulopathy or
thrombocytopenia
• Active gastritis or peptic ulcer disease
• History of total gastrectomy
• Severe ascites
• Active peritonitis

6. Types
Open gastrostomy
• Stamm’s
• Janeway’s
Percutaneous endoscopic gastrostomy(PEG)

7. Procedure
Open gastrostomy; There are many types of open
gastrostomy but the commonly used types are the Stamm
and Janeway gastrostomy
• Preoperatively; baseline investigations, plain
abd.xray, upper G.I endoscopy, NPO, consent
• Anaesthesia; local, general
• Positioned and Skin prep

8. • Incision; small upper midline, left subcostal
• The peritoneal cavity is entered and the anterior
wall of the stomach is grasp with two pairs of
Babcock forceps and the stomach drawn unto the
surface. The stomach is incised to allow insertion
of a 12 or 14Fr forley catheter whose balloon is
then inflated. Leakage along side the catheter is
prevented in one of two ways; Stamm’s or
Janeway’s.

9. • Stamm’s method; two purses string suture of non-
absorbable material are inserted concentrically
around the tube, the 1st
1cm from the tube. This is
then inverted by a second concentric suture 2cm
from the tube. When drawn tight, these suture
invaginate the catheter.
• Janeway’s method; a valve is created by burying
the tube in a short tunnel in the stomach wall.
The tube is brought out through a stab incision on the
anterior abdominal wall. To further prevent leakage,
the anterior gastric wall is sutured to the parietal
peritoneum at the region of the tube. With interrupted
sutures.

11. Percutaneous endoscopic gastrostomy
• Reduced morbidity and mortality compared to open.
• The fiber optic endoscope is passed into the stomach and
directed towards the anterior abdominal wall.
• The second operator identify it by transillumination and guide
it to the ideal site of placement of the tube.
• A cannula is passed by the abdominal operator
percutaneously into the stomach, he then pass a thread
through the cannula.
• This thread is grasped under direct vision by the endoscopist
using biopsy forceps and drawn back through the mouth.
• The gastrostomy tube is securely anchored to the thread
which is pulled by the abdominal operator delivering it through
the mouth, esophagus, stomach and through the anterior
abdominal wall.
• The tube secured on the skin with nylon

13. Post Op.
Feeding is usually after 24hours. When bowel sounds
are heard.
Patient is taught how to care for the tube and to
recognize infection.
Complications;
Infection
Trauma to other structures eg colon
Hemorrhage
Leakage
Blockage
Aspiration pneumonia
Displacement of tube

14. Conclusion
• Since its introduction, gastrostomy has
gained world-wide acceptance as a safe
technique for providing enteral feeding in
patients with poor oral intake who have a
functional GI system.

15. References
• http://emedicine.medscape.com/article/149665-overview#a2. Retrieved on the 2nd
March, 2016
• Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced
dementia.Cochrane Database Syst Rev. 2009;(2):CD007209. [PubMed]
• Kimyagarov S, Turgeman D, Fleissig Y, Klid R, Kopel B, Adunsky A. Percutaneous
endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not
associated with improved body composition parameters. J Nutr Health
Aging. 2013;17:162–165. [PubMed]