Gastrostomy

Definition

Gastrostomy is a surgical procedure for inserting a tube through the abdomen wall and into the stomach. The tube is used for feeding or drainage.

Purpose

Gastrostomy is performed because a patient temporarily or permanently needs to be fed directly through a tube in the stomach. Reasons for feeding by gastrostomy include birth defects of the mouth, esophagus, or stomach, and problems sucking or swallowing.

Gastrostomy is also performed to provide drainage for the stomach when it is necessary to bypass a longstanding obstruction of the stomach outlet into the small intestine. Obstructions may be caused by peptic ulcer scarring or a tumor.

Precautions

Gastrostomy is a relatively simple procedure. As with any surgery, patients are more likely to experience complications

if they are smokers, obese, use alcohol heavily, or use illicit drugs. In addition, some prescription medications may increase risks associated with anesthesia.

Description

Gastrostomy, also called gastrostomy tube insertion, is surgery performed by a general surgeon to give an external opening into the stomach. Surgery is performed either when the patient is under general anesthesia— where the patient feels as if he is in a deep sleep and has no awareness of what is happening—or under local anesthesia. With local anesthesia, the patient is awake, but the part of the body cut during the operation is numbed.

A small incision is made on the left side of the abdomen; then, an incision is made through the stomach. A small, flexible, hollow tube, usually made of polyvinylchloride or rubber, is inserted into the stomach. The stomach is stitched closed around the tube, and the incision is closed. The procedure is performed at a hospital or free-standing surgery center.

The length of time the patient needs to remain in the hospital depends on the age of the patient and the patient's general health. In some cases, the hospital stay can be as short as one day, but often is longer. Normally, the stomach and abdomen heal in five to seven days.

The cost of the surgery varies, depending on the age and health of the patient. Younger, sicker patients require more intensive, thus more expensive, care.

Preparation

Prior to the operation, the doctor will perform endoscopy and take x rays of the gastrointestinal tract.

Blood and urine tests will also be performed, and the patient may meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia.

Aftercare

Immediately after the operation, the patient is fed intravenously for at least 24 hours. Once bowel sounds are heard, indicating that the gastrointestinal system is working, the patient can begin clear liquid feedings through the tube. Gradually feedings are increased.

Patient education concerning use and care of the gastrostomy tube is very important. Patients and their families are taught how to recognize and prevent infection around the tube, how to feed through the tube, how to handle tube blockage, what to do if the tube pulls out, and what normal activities can be continued.

Risks

There are few risks associated with this surgery. The main complications are infection, bleeding, dislodgment of the tube, stomach bloating, nausea, and diarrhea.

Normal results

The patient is able to eat through the gastrostomy tube, or the stomach can be drained through the tube.

BOOKS

Griffith, H. Winter. Complete Guide to Symptoms, Illness, & Surgery. 3rd ed. New York: The Body Press/Perigee, 1995.

OTHER

"Stomach Tube Insertion." HealthAnswers.com. <http://www.healthanswers.com>.

Tish Davidson

KEY TERMS

Endoscopy—A procedure in which an instrument containing a camera is inserted into the gastrointestinal tract so that the doctor can visually inspect the gastrointestinal system.