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SURGICAL GASTROSTOMY BASED ON ENDOSCOPIC CONCEPTS - PubMed

SURGICAL GASTROSTOMY BASED ON ENDOSCOPIC CONCEPTS

[Article in English, Portuguese]

Emmanuel Conrado Souza. Arq Bras Cir Dig. 2016 Mar.

Abstract

Background: Until the early 1980s, Stamm technique was considered standard method to gastrostomy. After description of the endoscopic technique, due to its efficiency and speed, quickly became the method of choice for long-term enteral access.

Aim: Describe a technique that combines direct view of the stomach from open surgery with the simplicity and less traumatic endoscopic gastrostomy method.

Method: In patient supine under spinal anesthesia the technique stars with small epigastric incision to pull up the stomach. A 3 mm incision in the left hypochondrium is made to pass needle puncture to guidewire passage. The stomach is drilled, guidewire is seizured, connection to catheter and percutaneous approach is made with traction of the stomach to the abdominal wall. Purse suture on the anterior gastric wall is not needed.

Results: Twenty-eight patients underwent gastrostomy using endoscopy devices; six had local minor complications without the need for re-intervention; there was no death.

Conclusion: The surgical gastrostomy with minimal incision in the stomach to pull off the catheter using endoscopic gastrostomy devices, proved to be safe, easy to perform, less traumatic, quick, simple and elegant.

Até 1980, a técnica de Stamm era padrão para gastrostomia. Após introdução da técnica por via endoscópica, devido a sua eficiência e rapidez, rapidamente tornou-se método de escolha para acesso enteral prolongado.

Objetivo:: - Descrever uma técnica que combina a visualização direta do estômago pela laparotomia com a simplicidade e menor trauma oferecida pela gastrostomia endoscópica.

Método:: A técnica é laparotômica com o paciente em decúbito dorsal sob raquianestesia. Inicia-se com incisão pequena no epigástrio e tração do estômago através dela. Associa-se incisão de 3 mm em flanco esquerdo para punção com agulha permitindo a passagem de fio guia. A seguir, realiza-se perfuração punctiforme do estômago, apreensão do fio guia, conexão com sonda e tração percutânea com aproximação do estômago à parede abdominal sem necessidade de sutura em torno da sonda.

Resultados:: Vinte e oito pacientes foram submetidos à essa técnica com dispositivos usados pela endoscopia; seis apresentaram complicações locais menores, sem necessidade de reintervenção; não houve óbito.

Conclusão:: A gastrostomia cirúrgica com incisão mínima no estômago para exteriorização da sonda, utilizando dispositivos da gastrostomia endoscópica, mostrou-se segura, de fácil execução, menos traumática, mais rápida, simples e elegante.

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Conflict of interest statement

Conflicts of interest: none

Figures

FIGURE 1
FIGURE 1. - Surgical technique of gastrostomy: A) guidewire passage perpendicularly to the abdominal wall under direct vision with its externalization through the incision; B) identification and seizing the gastric antrum with atraumatic forceps, gastrostomy location, spot-drilling perfuration in the distal antrum 5 cm from the site already undertaken to guidewire to be used for future passage of gastrostomy probe; C) seizure of the guidewire, connection with gastrostomy tube, smooth traction until the flange shaped element of the probe get into the stomach in close contact with the mucosa; D) after placement of the external fixing elements, the stomach probe is retracted against the abdominal wall - laparoscopic vision; E) suture of the gastric incision with nonabsorbable stitches far away from gastrostomy tube exit - laparoscopic vision; F) skin suture and placement of external elements finish the procedure

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