Gastrostomy

Gastrostomy

Gastrostomy is a surgery to create an opening (stoma) in the abdominal wall into the stomach, through which feeding, fluids and medications are given when oral intake is not feasible or safe. 

What is the purpose of a Gastrostomy?

It is commonly prescribed when an individual requires prolonged nutritional assistance and cannot ingest sufficiently either through mouth.

Some of the more frequent indications are:

• Neurologic 
• Stenosis 
• Head and neck cancers
• Dysphagia
• Long-term ventilation or critical condition.
• Developmental defects in infants.

Types of Gastrostomy

Percutaneous Endoscopic Gastrostomy

• Most common method
• Administered by endoscope via the mouth.
• Minimally invasive

Open Gastrostomy

• Carried out through an abdominal slit.
• Used when PEG is not feasible

Laparoscopic Gastrostomy

• Little invasive surgical procedure.
• Often used in children

Radiologically Inserted Gastrostomy

• Fluoroscopy guided (imaging) done.

Benefits of Gastrostomy

• Long term nutrition stable.
• Supports growth and healing (especially in children)
• Removes risk of aspiration unlike NG tubes. 
• More comfortable to use in the long run.

Gastrostomy tube placement

Gastrostomy tube (G-tube) placement is surgery to place a feeding tube into a baby’s stomach through the abdominal skin. 

When Should G-tube Placement Be Needed? 

If the feeding difficulty is expected to be more than 4-6 weeks, it is advisable.

Common indications:

• Difficult swallowing 
• Neurogenic
• Esophageal atresia, strictures or post-operative diversion.
• Head and neck cancers
• Failure to thrive in infants
• Patients under long term ventilated or in critical conditions.

Gastrostomy surgery

The goal of a gastrostomy operation is to establish a window between the abdominal wall & stomach for enteral feeding when the individual is unable to eat by mouth, or the oral route is either incompletely safe or not available for a longer duration. 

Preparation before Surgery

• Clinical assessment and permission.
• Blood tests + imaging where necessary.
• Fasting for 6–8 hours
• Preoperative antibiotics.
• General anaesthesia (majority in the surgical cases)

There are different forms of Surgical Gastrostomy

• Open gastrostomy
• Laparoscopic gastrostomy

Procedure:

Anaesthesia & Positioning

• Patient lies supine
• General anaesthetic agent given.
• Abdomen cleaned and draped

Abdominal Access

• Open method: Small incision made on the upper-abdomen.
• Laparoscopic technique: camera 2-3 small keyhole incisions.

Identification of Stomach

• Placed in the stomach and brought to the abdominal wall.
• Assures that no bowel is interposed.

Creation of Gastric Opening

• Incisions on the stomach (gastrotomy) are located small.
• Sutures put round the opening (purse-string).

Tube Placement

• Gastrostomy tube by the abdominal wall inside the stomach.
• Tube fastened with balloon or sutures.

Fixation (Gastropexy)

• Stomach fixed on abdominal wall.
• Avoids leakage and displacement.

Closure

• Abdominal incisions closed
• Tube position checked

Duration of Surgery

• 30-60 minutes (can be different depending on the patient and method)

Post-operative Care

• Pain, bleeding, infection monitoring.
• Feeding starts in 24–48 hours
• Caregivers taught about tube site care.
• Hospital stay: 2–4 days

Pediatric gastrostomy

Pediatric gastrostomy is an operation whereby a tube is inserted into the stomach of a child to administer long-term nutrients, fluids as well as medications in cases where oral feeding is unsafe or insufficient. It is usually done among infants and children including the newborns.

What is the Reason why Gastrostomy is required in children?

Common Indications:

• Neurological disease
• Anomalies congenital.
• Failure to thrive 
• Coughing disorders / aspiration risk.
• Genetic or metabolic diseases.
• The assistance with feeding post-surgery.
• Dependence on nasogastric tubes Long-term dependence on nasogastric tubes.

Gastrostomy recovery

Gastrostomy recovery is the healing of the gastrostomy (G-tube) and the adjustment of the child or the patient to tube feeding. In most cases, recovery is easy in case the right care is taken.

Quick Recovery (FIRST 24-48 HOURS)

• Mild pain, swelling, or redness at the tube site. 
• \Child can be cranky or drowsy (anaesthesia)
• IV fluids until the commencement of feeds.
• Before feeding, tube position was checked.
• Nourishment normally commences in 12-48 hours.

Hospital Stay

• PEG: Same day to 1–2 days
• Surgical / pediatric gastrostomy: 2-4 days.

Parents or caregivers receive training in:

• Tube feeding
• Site cleaning
• Recognizing warning signs

First 1–2 Weeks at Home

• Stoma starts healing
• Light leakage or crusting is normal.
• Pain reduces significantly
• Pulling on the tube too hard should be avoided.
• Bathing permitted after 7-10 days (as recommended)

Feeding During Recovery

• Start with small, slow feeds
• Gradually increase volume
• Tolerance-based bolus/continuous feeds.
• Burgering/venting of the tube assists in alleviating pain.

Activity & Comfort

• Normal mild exercises permitted.
• Infants do not take tummy pressure at first.
• Until he is fully healed no heavy playing or swimming.
• Loose clothing recommended

Tube Site Care

• Wash in light soap and water daily.
• Keep site dry
• Turn tube every day (following healing)
• Pre-feed and post-feed flush tube.
• Close tube in order to avoid its inadvertent loss.

Gastrostomy complications

Gastrostomy is a relatively safe operation particularly in children although, like any surgery, or a tube that is placed in the long term, complications may arise. Majority of them are small and manageable upon their early identification and good care.

Common (Minor) Complications

• Skin Infection / Redness
• Leakage Around the Tube
• Granulation Tissue
• Tube Blockage
• Tube Dislodgement

Moderate Complications

• Vomiting & Feeding Intolerance
• Buried Bumper Syndrome (PEG)
• Peristomal Pain

Serious (Rare) Complications

• Peritonitis
• Bleeding
• Injury to Nearby Organs

Best hospital for gastrostomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Gastrostomy is an effective, safe, and reliable feeding method of patients, mostly children, who are not able to satisfy their nutritional requirements orally. It offers long-term nutritional support when properly indicated and done, improve growth and recovery, lowers the risk of aspiration, and significantly enhances the quality of life of patients and caregivers when properly done. The majority of gastrostomy-related problems are not serious and can be avoided and easily solved by means of proper technique, stoma care, and education of caregivers. Severe complications are uncommon and are typically linked to preterm tube obstruction or delayed treatment. Gastrostomy allows safe home feeding and promotes the general development and recovery because it is a multidisciplinary approach that incorporates surgeons, pediatricians, dietitians, and trained caregivers. In most cases, gastrostomy is a temporary and reversible intervention as the tube may be removed when oral feeding is sufficient.

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FAQ

1. Is gastrostomy a major surgery?

• It is a minor to moderate procedure. A lot of gastrostomies are performed laparoscopically or using a percutaneous endoscopic gastrostomy (PEG) technique.

2. Can you do a gastrostomy in a newborn baby and a child?

• Yes. When performed by experienced surgical teams, neonatal and pediatric gastrostomy is routine and safe.

3. Is gastrostomy painful?

• Mild pain or discomfort is to be expected for a couple of days, and can be easily managed with medication.

4. Can children eat by mouth if they have a gastrostomy tube?

• Yes. If swallowing is safe, oral feeding can begin or continue alongside tube feeding.

5. How long does a gastrostomy tube remain in place?

• Depending on the child’s feeding needs, it can last for years or months. Eventually, a lot of children have it taken out.

6. Is a gastrostomy permanent?

• Usually it is for a limited time, particularly in children. The tube can be removed once oral feeding is sufficient.

7. Does the hole close when the tube is removed?

• Yes. The stoma usually closes of its own in a few days.