Choice of laparotomic gastrostomy method in a palliative patient

Abstract

Minimally invasive percutaneous endoscopic gastrostomy is currently the surgery of choice in debilitated palliative patients. However, the use of minimally invasive techniques is not always possible. Therefore, laparotomic methods of applying a gastrostomy remain in demand. The analysis of the technique for performing the most common operations is carried out and the minimum area of the wall of the stomach necessary for imposing a fistula is calculated. The dimensions of the area of the wall of the stomach used for gastrostomy affect the degree of reduction and deformation of the stomach and can be used as a comparison criterion. Gastrostomy tubes of 1 cm in diameter are traditionally used. To create a linear channel (Witzel gastrostomy, tubular gastrostomy and others), one needs as minimum 26 cm2 of the stomach wall. About 78 cm2 of the anterior stomach wall is required for Stamm-Senn-Kader or Toprover gastrostomy. A smaller area of the stomach wall could be used for Witzel and tubular gastrostomies (according to Depage and others) leading to lesser deformation of the stomach. The use of thinner gastrostomy tubes with an external diameter of 0.6 cm (18Fr) significantly reduces the area of the anterior wall of the stomach used and correspondently the risk of complications. The use of a Foley catheter or similar in design proprietary low profile gastrostomy tubes reduces the risk of a gastrostomy tube falling out of the fistula, and the cylinders at the end create an additional valve.