gastrostomy
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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 long-standing 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.
Gastrostomy is a procedure in which the surgeon makes an opening into the stomach and inserts a feeding tube for feeding or for drainage.
(Illustration by Electronic Illustrators Group.)
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.
Resources
Other
"Stomach Tube Insertion." HealthAnswers.com. http://www.healthanswers.com.
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.
gastrostomy
[gas-tros´tah-me]the creation of an opening into the stomach. This procedure is done to provide for the administration of food and liquids when stricture of the esophagus or other conditions make swallowing impossible. In the past gastrostomies were carried out in the operating room through an abdominal incision and formal laparotomy. Advances in endoscopic technology have led to techniques of introduction of the tube in a minimally percutaneous manner. Tubes placed in this fashion need special placement and a health care provider should be consulted before the tube is manipulated.
Patient Care. A patient who is to undergo this type of surgery usually has been ill for some time and often has nutritional deficiencies brought on by a steadily increasing difficulty in swallowing. Sometimes the patient is a small child who has accidentally swallowed lye or some other caustic substance, or it may be an adult who has taken a corrosive poison in an attempted suicide. Some elderly patients with obstructive carcinoma of the esophagus or throat may also require gastrostomy.
A primary consideration in the care of these patients is their acceptance of the gastrostomy as a substitute for eating. There are many social and emotional factors associated with eating and sharing a meal with others. Health care providers must be sensitive to the problems these patients will encounter in their adjustment to the changes a gastrostomy may bring to their lives. Whenever possible patients are taught self care in preparation of food, the feeding procedure, and peristomal skin care. It is important that they have privacy while doing this and that they be encouraged to ask questions and seek assistance from the members of the health care team.
The skin around the opening must be protected from irritation by the gastric juices, which may leak from the opening and act as a corrosive on the skin. In some cases the gastrostomy tube can be removed after each feeding. A device called the Barnes-Redo prosthesis is available for use by patients with a permanent gastrostomy; it is designed so that a cap can be fitted over a nylon tube permanently installed in the opening. When food or liquids are to be given the cap is unscrewed and a catheter is passed into the nylon tube. After feeding is completed the catheter is removed and the cap is screwed tightly over the nylon tube.
Feedings for a gastrostomy patient are gradually increased according to tolerance. At first, water and glucose are given at regular intervals. If there is no leakage and the patient has no difficulty with these liquids, other liquids and puréed foods are gradually added until a full meal can be tolerated.
In order to stimulate gastric secretions and aid digestion, these patients should see, smell, and taste small amounts of food before each feeding. It is recommended that they be allowed to chew small bits of food even though they cannot swallow them. This allows for proper stimulation of the gums and teeth and helps promote the health of the mouth and teeth.
Feedings should be warmed before they are given through the tube. Although commercially prepared liquid feedings are more convenient, they often cause diarrhea and are not as nutritionally adequate as regular meals. The foods to be given through the tube should be cooked until they are soft and then puréed in an electric blender. They can be diluted with the water in which they have been cooked, so that no vitamins are lost. A clinic dietitian usually must work very closely with the patient and family, instructing them in the planning and preparation of the patient's meals and offering suggestions for a variety of foods that will provide a well-balanced diet.
A primary consideration in the care of these patients is their acceptance of the gastrostomy as a substitute for eating. There are many social and emotional factors associated with eating and sharing a meal with others. Health care providers must be sensitive to the problems these patients will encounter in their adjustment to the changes a gastrostomy may bring to their lives. Whenever possible patients are taught self care in preparation of food, the feeding procedure, and peristomal skin care. It is important that they have privacy while doing this and that they be encouraged to ask questions and seek assistance from the members of the health care team.
The skin around the opening must be protected from irritation by the gastric juices, which may leak from the opening and act as a corrosive on the skin. In some cases the gastrostomy tube can be removed after each feeding. A device called the Barnes-Redo prosthesis is available for use by patients with a permanent gastrostomy; it is designed so that a cap can be fitted over a nylon tube permanently installed in the opening. When food or liquids are to be given the cap is unscrewed and a catheter is passed into the nylon tube. After feeding is completed the catheter is removed and the cap is screwed tightly over the nylon tube.
Feedings for a gastrostomy patient are gradually increased according to tolerance. At first, water and glucose are given at regular intervals. If there is no leakage and the patient has no difficulty with these liquids, other liquids and puréed foods are gradually added until a full meal can be tolerated.
In order to stimulate gastric secretions and aid digestion, these patients should see, smell, and taste small amounts of food before each feeding. It is recommended that they be allowed to chew small bits of food even though they cannot swallow them. This allows for proper stimulation of the gums and teeth and helps promote the health of the mouth and teeth.
Feedings should be warmed before they are given through the tube. Although commercially prepared liquid feedings are more convenient, they often cause diarrhea and are not as nutritionally adequate as regular meals. The foods to be given through the tube should be cooked until they are soft and then puréed in an electric blender. They can be diluted with the water in which they have been cooked, so that no vitamins are lost. A clinic dietitian usually must work very closely with the patient and family, instructing them in the planning and preparation of the patient's meals and offering suggestions for a variety of foods that will provide a well-balanced diet.
Gastrostomy. From Lammon et al., 1995.
gas·tros·to·my
(gas-tros'tŏ-mē),Establishment of a new opening into the stomach.
[gastro- + G. stoma, mouth]
gastrostomy
/gas·tros·to·my/ (gas-tros´tah-me) surgical creation of an artificial opening into the stomach, or the opening so established.gastrostomy
(gă-strŏs′tə-mē)n. pl. gastrosto·mies
Surgical construction of a permanent opening from the external surface of the abdominal wall into the stomach, usually for inserting a feeding tube.
gastrostomy
[gastros′təmē]
Etymology: Gk, gaster + stoma, mouth
surgical creation of an artificial opening into the stomach through the abdominal wall. It is performed to prevent malnutrition and starvation in patients who have esophageal cancer or tracheoesophageal fistula, who may be unconscious for a prolonged period, or who are unable to swallow as a result of a cerebrovascular accident, Alzheimer's disease, or another disorder. It also permits retrograde dilation of an esophageal stricture. The anterior wall of the stomach is drawn forward and sutured to the abdominal wall. A Foley catheter or other tube or a special prosthesis is then inserted into an incision in the stomach, and the opening is tightly sutured to prevent leakage of the stomach contents. The device is clamped and is opened when liquid food supplement is instilled. After surgery glucose water may be given, followed by a slow continuous feeding of a warm blended formula to increase absorption. The skin is kept clean and dry around the site. Skin irritation indicates leakage of gastric secretions and digestive enzymes.
gastrostomy
A surgically created opening in the anterior wall of the stomach, which allows feeding while bypassing the oesophagogastric junction.gastrostomy
GI disease A surgical opening into the stomach which can be used for feeding usually via a gastrostomy tube. See PEG tube.gas·tros·to·my
(gas-tros'tŏ-mē)Establishment of a new opening into the stomach.
[gastro- + G. stoma, mouth]
gastrostomy
(găs-trŏs′tō-mē))
GASTROSTOMY BUTTON
Surgical creation of a gastric fistula through the abdominal wall, used, e.g., for introducing food into the stomach. See: illustration
Patient care
The skin around the tube is inspected for signs of irritation or excoriation and kept clean, dry, and protected from excoriating gastric secretions. Tension on the tube that may cause the incision to widen and allow spillage of gastric secretions on the skin or into surrounding tissues is prevented.
Before the patient is fed, tube patency and position are assessed, and the volume of the remaining stomach contents is measured by aspirating the stomach. If the volume is greater than the amount permitted by protocol or the physician's direction, feeding is withheld. The patient should be placed in high Fowler’s position during feedings, and the blenderized food or formula administered slowly by gravity in the prescribed amount (200 to 500 ml). Encouraging the patient to chew prior to enteral feeding promotes gastric secretions to aid digestion. After feedings and after introduction of medications, the tube is flushed with an adequate amount of water (at least 60 ml). Fluid intake and output (which includes aspirated feeding) should be monitored and recorded.
Assistance is provided with oral hygiene at intervals throughout the day to prevent dryness and parotitis. Both patient and family are taught correct techniques for tube and skin care and for feeding through the gastrostomy tube, for keeping track of intake and output, and concerns to be reported to the primary care provider.
percutaneous endoscopic gastrostomy
Abbreviation: PEGA feeding ostomy. PEG tubes are inserted transorally into the stomach with the aid of an endoscope and then pulled through a stab wound made in the abdominal wall.
gastrostomy
A surgical opening made into the stomach with the formation of a temporary or permanent passage from the outer surface of the abdomen, for purposes of feeding or drainage.gas·tros·to·my
(gas-tros'tŏ-mē)Establishment of a new opening into the stomach.
[gastro- + G. stoma, mouth]
gastrostomy,
n the surgical creation of an artificial opening into the stomach through the abdominal wall, used to feed a patient who has cancer of the esophagus or other kind of barrier to oral feeding.
gastrostomy
the creation of an opening into the stomach.
blind gastrostomy
placement of a gastric feeding tube without laparotomy or endoscope, simply by manipulating the end of the tube through the stomach and body wall.
percutaneous gastrostomy
used for placement of a gastric feeding tube. An endoscope is used to position an incision through the body wall and stomach wall, to grasp and withdraw a suture inserted through the opening and to guide the placement of the tube which is pulled back into the stomach and through the opening by traction on the suture which has been attached to the distal end of the tube.
tube gastrostomy
as part of the surgical correction of gastric dilatation-volvulus, an inflatable catheter can be used to maintain traction on the stomach, provide fixation, and allow decompression.