Gastrostomy

A gastrostomy is a surgical procedure to make a hole into the stomach through the abdomen to insert a feeding tube into the stomach.

This procedure is performed in individuals who have disorders that cause swallowing difficulty, food going down the windpipe (aspiration), or other concerns. A gastrostomy feeding tube helps to bypass the mouth and throat, and delivers food directly into the stomach. A feeding solution containing all the essential nutrients is fed through the gastrostomy tube to fulfil the person's nutritional requirements. In addition to food, medicines can also be delivered through the tube.

This procedure is performed to deliver food either temporarily or permanently.

A surgeon may recommend this procedure in children or adults with the following conditions:

• Birth defects of the stomach, oesophagus, or mouth
• Inability to take enough food to stay healthy
• Inability to swallow food properly
• Increased risk of breathing in food

The surgery may also be performed for the following purposes:

• To deliver medicines during the treatment of cancer or blood disorders
• To remove contents of the stomach if needed
• To reduce bloating

A surgeon may not recommend this procedure in individuals with the following conditions:

• Serious disorders that affect blood clotting
• Sepsis
• History of gastrectomy
• Peritonitis
• Severe ascites
• Infection at the insertion site of the feeding tube
• Severe gastroparesis (a condition in which our body is unable to push food of the stomach as quickly as it should)
• Marked peritoneal carcinomatosis

You may need to share the following details with the surgeon before the surgery:

• Your health history including any allergies that you may have.
• Previous history of reaction to the dye used in imaging tests
• If you have any medical conditions
• List of all the medicines, herbs, and vitamin supplements that you take
• If you are taking any blood-thinning medicines such as aspirin and warfarin

The following preparations are needed before the procedure:

• You should have a shower and hair wash the night before the surgery.
• Avoid drinking or eating anything for six hours before the procedure as it may decrease the risk of stomach contents entering the lungs during the procedure.
• Do not wear any jewellery or nail varnish to the surgery.
• You will need to sign a consent form before the surgery allowing the surgeon to perform the procedure on you.

After admission to the hospital, you will be asked to wear a hospital gown. You can expect the following before the procedure:

• The medical staff will insert an intravenous (IV) line in your arm or hand to provide fluids and medicines. 
• You will then be given a medicine to help you relax (sedative).
• The medical staff will shift you to the operating room.
• The anesthesiologist will then administer general anaesthesia, a sleep-inducing medicine. You will be asleep during the procedure.
• An endotracheal tube will be inserted down your throat into your windpipe. This tube will assist you in breathing during surgery.
• Another tube called nasogastric tube will be inserted into your stomach through your mouth or nose to remove fluids from your stomach. These tubes will be removed when you are able to breathe and eat well.

The surgeon may insert the gastrostomy tube by any of the following three methods:

Percutaneous endoscopic gastrostomy (PEG): This procedure includes the following steps:

• The surgeon will insert a thin, flexible tube with a camera (an endoscope) into your stomach through your mouth and make a minor incision in the skin over your stomach.
• He/she will insert a needle into your stomach through this incision.
• With the needle, the surgeon will pass a thin wire into your abdomen and attach it to a special tip of the endoscope.
• The surgeon will then pull the endoscope with the wire up to your mouth and attach a gastrostomy tube to the end of the wire.
• He/she will then pull the wire from the end of your abdomen to bring down the gastrostomy tube into your stomach.
• Once the tube is in place, the surgeon will remove the wire and endoscope and close your stomach with stitches.
• The gastrostomy tube will be held in its position using a small device called a bumper. A bumper can be both internal (round or X-shaped) and external (disc-shaped) and keeps the tube secured to the abdominal wall. 

Laparoscopic technique: This can be performed in the following manner:

• The surgeon will make a small incision in your belly button and insert a blunt-tipped needle into your abdominal cavity.
• He/she will push carbon dioxide gas into your abdomen to inflate it. This helps to clearly look into the abdominal organs.
• Next, the surgeon will make several other small incisions in your abdominal skin and insert small instruments.
• A wire will then be inserted into your stomach through a needle in one of the incisions, and the gastrostomy tube will be inserted into the stomach using this wire as a guide.
• Once that is done, the surgeon will close your stomach with stitches. A small balloon-like structure present at the end of the tube helps to hold the stomach in its position against the abdominal wall.

Open surgery: This is performed as follows:

• The surgeon will make a cut on the left or middle of your abdomen and through your stomach.
• He/she will insert a hollow tube (the gastrostomy tube) into your stomach and then stitch your stomach around the tube like a cuff.
• The surgeon will also stitch the abdominal wall around the tube.
• A tiny balloon helps to keep the tube in place.

The surgery may last for 30 to 45 minutes, and the following things can be expected after the procedure:

• You will be shifted to a recovery room.
• After waking up, you may feel confused, groggy, or nauseated.
• Inform the surgeon if you feel pain at the incision site. The surgeon may prescribe medicine for the same.
• The medical staff will tell you how to feed through the gastrostomy tube and what to feed. They will also show how to use the tube to empty liquids and air from the stomach if you are unable to vomit or burp. A nutritionist can help you plan a diet.
• The IV line will be removed at the time of discharge.
• You will require a hospital stay for one to two days.

You will need to take the following care at home:

Wound care: 

• Do not splash water on the wound for at least a few days after the surgery. only clean the skin around the surgical site gently. You can wash the area properly during a bath when your doctor allows you to.
• It is normal to experience some leakage from the incision site. You can clean the area with damp gauze.

Care of the tube:

Different types of gastrostomy tube need to be cared for differently. A nurse or your doctor will tell you how to care for the tube.

If the gastrostomy tube comes out accidentally, call your doctor immediately as the hole can close within a few hours. If you are given a spare tube to insert into the gastrostomy hole for such a condition, insert it in the opening quickly as explained by the doctor. This is because the gastrostomy opening closes quickly.

Taking medications through the tube: The tube can get blocked while taking tablets. So, if you have to take medicines for a health condition after the surgery, it is best that you tell your doctor about the tube so he can give you liquid medication.

If a tablet is still prescribed, then ground the tablet finely and mix with boiled water that should be cooled and then give it through the tube.

Additionally, flush the feeding device with water between each medicine delivery to prevent drug interaction and tube blockage.

Oral health: 

• Brush your teeth twice regularly even if you do not eat or drink anything through the mouth.
• Use a water spray in the mouth if it feels dry.

Activities: You can swim once the surgical opening has healed. However, avoid indulging in contact sports as it can dislodge the device from its position. Discuss with the surgeon before making plans for travel.

Gastrostomy is a life-saving procedure and is often well-tolerated. It allows people to return to their daily activities.

When to see the doctor?

Call or visit the surgeon if you experience any of the following:

• Bleeding at the incision site
• Severe pain during delivery of medicines or feeding through the gastrostomy tube
• Leakage of stomach contents or feed from the incision site
• A dislodged tube
• Diarrhoea or vomiting
• Trouble emptying your bowels

The risks involved with the procedure include:

• Infection at the tube insertion site.
• Injury to the gut during the needle insertion It may require an operation or special treatment.
• Blockage of tube or movement of the tube from its original position
• Excessive bleeding 

Sometimes, the surgeon is unable to insert the gastrostomy tube. In such cases, the surgeon will explain the reason and suggest other alternatives.

You will be provided with an appointment for a follow-up visit before you are discharged from the hospital. During the follow-up visits, the surgeon will monitor the condition that caused swallowing difficulty and decide whether you should continue with the gastrostomy tube.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.