COMPARISON OF DIFFERENT GASTROSTOMY METHODS ACCORDING TO OBJECTIVE CRITERIA

Abstract

Gastrostomy is a forced operation in patients suffering from dysphagia. Patients do not have the opportunity to independently compare different methods of gastrostomy, so it is impossible to focus on their subjective assessment. Objective criteria for comparison are needed to select a gastrostomy technique. The dimensions of the stomach wall area used in gastrostomy affect the volume and deformation of the stomach, and therefore can be used as a comparison criterion. The aim of the article is to compare different methods of gastrostomy according to objective criteria. To compare the most common methods of gastrostomy, an analysis of the operation technique was carried out. Using the laws of geometry, the dimensions of the stomach wall used for the formation of fistulas were calculated without taking into account the sutures for gastropexy. With puncture gastrostomy, the area of the stomach wall used corresponds to the area of the internal pressure plate (bumper). For a 15 Fr percutaneous endoscopic gastrostomy tube with an internal bumper diameter of 2.3 cm, the area of the stomach wall used is 4.2 cm². When using a gastrostomy tube with a diameter of 1.0 cm for calculations, Witzel gastrostomy requires about 31 cm² of the stomach wall, and for Stamm-Senn-Kader gastrostomy - 38.5 cm² of the stomach wall. Puncture methods of gastrostomy are optimal for patients who do not require additional interventions in the abdominal cavity. If puncture gastrostomy is not possible, it is advisable to use pressure gastrostomy through minilaparotomy, which is less traumatic than traditional operations. Laparotomic and laparoscopic gastrostomies with the formation of a fistula from the stomach wall are indicated if additional diagnostic and therapeutic interventions in the abdominal cavity are necessary. In this case, it is more expedient to use gastrostomy according to Witzel or proboscis type (according to Depage or others), in which the anterior wall of the stomach of a smaller area is used and there is less deformation of the stomach compared to gastrostomy according to Stamm-Senn-Kader.