General

Open gastrostomy

PEG

Laparoscopic gastrostomy

G-tube care

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GENERAL INFORMATION

Enteral access is one of the common procedures in pediatric surgery and therefore there is a large population of children with chronic, surgically placed enteral access tubes.

Gastrostomies are the most common and can be placed in a number of ways.

The Stamm gastrostomy requires laparotomy and results in a tube that is placed within the stomach, secured by 2 purse-string sutures and is anchored to the anterior abdominal wall from within. The tube is additionally anchored to the skin. This provides secure access, but requires laparotomy.

Percutaneous Endoscopic G-tubes avoid the need for laparotomy and depend on the traction exerted on the tube as it is anchored to the skin, to maintain contact between the gastric opening and the anterior abdominal wall. Potential complications include loss of contact between the stomach and abdominal wall resulting in intra-peritoneal soilage and injury to other viscera in the process of placement .

Laparoscopy-assisted G-tubes are anchored in a manner similar to the PEG. This procedure, however, avoids laparotomy, while minimizing the risk of injury to adjacent organs (colon) in the process of placing the G-tube.

The types of catheters used in each instance may be different. Operative G-tubes are generally Malekot or Pezzar catheters, which can simply be removed by traction.

PEG tubes often are tubes with rigid crossbars in the stomach, which precludes traction removal and requires another endoscopy for removal. Unlike the adult population, these tubes cannot simply be cut and allowed to pass through the GI tract of a young child. They have been associated with small bowel obstruction and case reports of esophageal erosion and perforation, due to devices "refluxing" into the esophagus where they become lodged.

The tubes used for laparoscopic G-tubes are either primary MIC-key buttons or other balloon catheters.

 

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