This procedure should be considered during abdominal operation in those poor-risk or elderly patients prone to pulmonary difficulties or where postoperative nutritional difficulties are anticipated. Gastrostomy is considered in the presence of obstruction of the esophagus, but it is most frequently employed as a palliative procedure in nonresectable lesions of the esophagus or as the preliminary step in treating the cause of the obstruction. A permanent type of gastrostomy may be considered for feeding purposes in the presence of almost complete obstruction of the esophagus due to nonresectable malignancy. The type of gastrostomy depends upon whether the opening is to be temporary or permanent.
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Stamm gastrostomy is a surgically placed feeding tube in the stomach. Incision Usually performed through a small cm upper midline incision but can be performed through a upper left lateral horizontal incision also. Surgical Details of the Stamm Gastrostomy Procedure 1. The incision is made in the skin with a No. The midline if vertical incision is used is found and carefully incised with a knife or Bovie cautery. The preperitoneal fat is retracted upwards with forceps on either side of the midline and incised carefully using Bovie cautery.
The peritoneum is grasped with forceps on either side of the midline and incised with a Metzenbaum scissors. The abdominal cavity is entered with care taken to take down any adhesions to the inner abominal wall with gentle traction and using the Metzenbaum scissors. Babcock clamps are used to grasp the anterior stomach wall in the mid to slightly distal stomach and to elevate it into the wound. A circular purse-string suture is placed with a diameter of 1.
A concentric purse-string of or silk is then placed just outside of the first purse-string with the ends left untied. A small opening is made in the serosa of the stomach in the center of the two concentric pursestring sutures, usually by placing the Bovie cautery onto the surface for a second. A hemostat is used to grasp the inner mucosal layer of the stomach and to pull it up through the opening made in the serosa.
This lip of mucosa is then amputated using the Bovie cautery. The hole in the anterior stomach is widened slightly by placing the tips of a closed hemostat into the hold and then spreading. A French Foley balloon catheter is then placed into the stomach through the just made opening. The balloon is inflated and then pulled up tight against the inner surface of the stomach. First the inner and then the outer sutures are cinched down and tied.
The stomach with the protruding Foley catheter is them moved up against the inside of the abdominal wall to see where the exit site of the Foley should be positioned. A stab wound is made in the skin with a No. Bovie cautery is used to control and skin bleeding, which is usually slight in Stamm gastrostomy. A Schnitt forceps is bluntly forced through the stab wound into the abdominal cavity and the tips are opened. The Foley catheter is fed onto one of the tips and the forceps is closed and pulled back out of the abdominal cavity, bringing the Foley catheter with it.
The inside anchoring sutures are then placed. This is done by first placing a silk suture through the stomach mucosa and then through the tissue on the underside of the abominal wall, but is left untied.
Cirugías y procedimientos: Sonda de gastrostomía
Gastrostomy (Stamm Gastrostomy)