Eski Bir Yöntem Olarak Açık Gastrostominin Uygulanabilirliği ve Güvenilirliği

Year 2018, Volume: 2 Issue: 3, 48 - 52, 29.12.2018

Mesut Yur , Erhan Aygen

Abstract

Amaç: Enteral nutrisyon için gastrostomi çoğunlukla endoskopik olarak yapılır. Endoskop veya diğer aygıtlar olmadığında veya faringoözofageal
obstrüksiyon olması halinde, açık teknik, lokal anestezi altında minilaparotomi ile uygulanabilir. Biz bu çalışmada, ihtiyaç halinde bu eski tekniğin
güvenilirlik ve uygulanabilirliğini sunmak istedik.

Araçlar ve Yöntem: Bu eski yöntemle 28 hasta opere edildi. Yöntem, ksifoidin hemen altından mini vertikal insizyon (2-3 cm) ile lokal anestezi
altında uygulandı. Gastrostomi tüpü, gastrotomi sonrası direk görüş altında mide duvarından girildi. Mide duvarı çift purse string dikişle dikildi. Tüp
sol subkostal karın duvarından dışarı çıkarıldı. Tüm veriler retrospektif olarak değerlendirildi.

Bulgular: Tüp gastrostomi, lokal anestezi altında minilaparotomi ile kolayca ve güvenle uygulandı. Herhangi bir komplikasyon gözlenmedi.
Ortalama operasyon süresi 36.07 ± 10.18 dakikaydı ve tüm hastalar operasyondan 24 saat sonra beslenmeyi tolere etti.

Sonuç: Minilaparotomi ile lokal anestezi altında yapılan tüp gastrostomi, ihtiyaç halinde güvenle ve kolayca yapılabilir. Bu eski tekniği, endoskop,
diğer enstrümanlar olmadığında veya özefagus obstrüksiyonu durumunda kullanabiliriz. Her ne kadar lokal anestezi altında minilaparotomi ile tüp
gastrostomi uygulaması kolay ve güvenli olsa da, tüp gastrostomiler için endoskopik yöntemler kullanılmalıdır.  

Keywords

Gastrostomi, laparotomi, nütrisyon

Feasibility and Reliability of Open Gastrostomy as an Old Method

Abstract

Purpose: Gastrostomy for enteral nutrition is often performed endoscopically. If an
endoscope or other instruments are not available or a pharyngoesophageal
obstruction is seen, an open gastronomy technique can beuseful under local
anesthesia using minilaparotomy. In this study, we aim to present the feasibility and reliability of this old
method when needed.

Materials and Methods: Twenty-eight patients were operated on using this old technique. The
operations were performed under local anesthesia with
a mini vertical incision (2-3 cm) just below the xiphoid process. A gastrostomy
tube was inserted through the gastric wall under direct vision after the gastrotomy. The gastric wall was fastened with
double-purse string sutures. The tube was taken out from the left subcostal
gastric wall. All the data were evaluated
retrospectively.

Results: A tube gastrostomy was performed easily and safely in all patients under
local anesthesia by way of a minilaparotomy. There were no observed complications. The mean operative time was 36.07 ±
10.18 minutes and all the patients tolerated feeding within 24 hours of the
operation.

Conclusion: A tube gastrostomy can be performed safely and easily under local
anesthesia by way of a minilaparotomy when necessary. We can use this old technique when we don’t have an endoscope, other
instruments or in case of an esophageal obstruction. Although this technique is
safe and easy to perform, endoscopic methods
should be used for tube gastrostomies.  

Keywords

Gastrostomy, laparotomy, nutrition

References

• 1. Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, Di Carlo V. Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet. Crit Care Med. 1998;26(1):24-302. Gianotti L, Braga M, Gentilini O, Balzano G, Zerbi A, Di Carlo V. Artificial nutrition after pancreaticoduodenectomy. Pancreas. 2000;21(4):344-351.3. Hossein SM, Leili M, Hossein AM.Acceptability and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement and patient quality of life. Turk J Gastroenterol. 2011;22(2):128-1334. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15(6):872-8755. Klose J, Heldwein W, Rafferzeder M et al. Nutritional status and quality of life in patients with percutaneous endoscopic gastrostomy (PEG) inpractice: prospective one-year follow-up. Dig Dis Sci 2003;48: 2057-20636. Loser C, Wolters S, Folsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci 1998;43: 2549-25577. Vassilopoulos PP, Filopoulos E, Kelessis N, Gontikakis M, Plataniotis G.Competentgastrostomy for patients with head and neck cancer. Support Care Cancer. 1998;6(5):479-4818. Bach JR, Gonzalez M, Sharma A, Swan K, Patel A. Open Gastrostomy for Noninvasive Ventilation Users with Neuromuscular Disease Am J Phys Med Rehabil. 2010;89(1):1-69. Faria GR, Taveira-Gomes A Open gastrostomy by mini- laparotomy: a comparative study. Int J Surg. 2011;9(3):263-26610. Zickler RW, Barbagiovanni JT, Swan KG. A simplified open gastrostomy under local anesthesia. Am Surg. 2001;67(8):806-80811. Foutch PG, Woods CA, Talbert GA, Sanowski RA. A critical analysis of the Sacks-Vine gastrostomy tube: a review of 120 consecutive procedures. Am J Gastroenterol. 1988;83(8):812-81512. Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987;93(1):48-52.13. Miller RE, Castlemain B, Lacqua FJ, Kotler DP. Percutaneous endoscopic gastrostomy. Results in 316 patients and review of literature. Surg Endosc. 1989;3(4):186-19014. Ponsky JL, Gauderer MW, Stellato TA, Aszodi A. Percutaneous approaches to enteral alimentation. Am J Surg. 1985;149(1):102-10515. Sangster W, Cuddington GD, Bachulis BL. Percutaneous endoscopic gastrostomy. Am J Surg. 1988;155(5):677-67916. Alley JB, Corneille MG, Stewart RM, Dent DL. Pneumoperitoneum after percutaneous endoscopic gastrostomy in patients in the intensive care unit. Am Surg. 2007;73(8):765-76717. Horiuchi A, Nakayama Y, Kajiyama M, Tanaka N. Effectiveness of outpatient percutaneous endoscopic gastrostomy replacement using esophagogastroduodenoscopy and propofol sedation. World J Gastrointest Endosc. 2012;16;4(2):45-4918. Bankhead RR, Fisher CA, Rolandelli RH. Gastrostomy tube placement outcomes:comparison of surgical, endoscopic, and laparoscopic methods. Nutr Clin Pract. 2005;20(6):607-61219. Ho HS, Ngo H. Gastrostomy for enteral access. A comparison among placement bylaparotomy, laparoscopy, and endoscopy. Surg Endosc. 1999;13(10):991-99420. Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed). 1982;27;284(6320):931-93321. Attard JA, MacLean AR. Adhesive small bowel obstruction: epidemiology, biology and prevention. Can J Surg. 2007;50(4):291-30022. Kiatipunsodsai S. Gastrostomy Tube Replacement Using Foley's Catheters in Children. J Med Assoc Thai. 2015;98(3):41-5.