Laparoscopic gastro-ostomy

Introduction
A gastrostomy involves creating an opening into the stomach to allow direct enteral feeding into the stomach. It is indicated for patients who cannot swallow or require tube feeding. This procedure eliminates the associated symptoms caused by the prolonged use of nasogastric tubes. The surgery is also suitable for patients who require drainage from the stomach. This procedure can be performed minimally invasively or as an open procedure, and can be arranged to be performed concurrently with a fundoplication if necessary.

Surgical procedure
The surgical procedure will be performed under general anaesthesia. Depending on the chosen surgical approach, the patient will have two or three small incisions (laparoscopic surgery) or an abdominal incision (open surgery) made to allow access to the abdominal cavity. The anterior wall of the stomach is sutured to the abdominal wall. A small incision (stoma) is made through the skin directly into the stomach, and a feeding tube is inserted into the stomach lumen, secured in place with a fixation plate or balloon, and can be sutured or left unsutured. The entire procedure generally takes 2 to 3 hours.

Risk
Common risks/complications

1. Complications of general anaesthesia
2. Wound infection
3. Bleeding wound
4. Minor abdominal organ damage
5. Granuloma
6. Mucosal prolapse
7. Weeping/peeling
8. Cage shift
9. Domestic pipe blockage/malfunction

Rare risk of serious consequences

1. Severe damage to abdominal organs
2. Stomach perforation
3. Peritonitis
4. Mismanagement of care
5. Gastrocolic fistula
6. Death

Pre-operative preparation
Patients must not eat or drink for 6 hours before surgery.

Post-operative care
Feeding can be resumed as early as 12 hours post-op (dependent on actual clinical circumstances). Tolerance to feeding, vomiting and abdominal pain should be carefully monitored. Check feeding tube displacement regularly.

Follow-up appointment
Patients should attend regular follow-up appointments at the specialist clinic. The condition and function of the feeding tube should be checked, and the condition of the skin around the stoma should also be monitored.

Notes
If the patient experiences abdominal pain or vomiting after discharge, a doctor should be notified immediately or the patient should go to the nearest emergency department for assistance. If the feeding tube becomes dislodged, do not attempt to reinsert it yourself. The child and the feeding tube should be taken to the nearest emergency department for treatment as soon as possible.
This leaflet is for reference only and does not list all possible complications. Other unforeseen complications may occur. The actual risks may differ for certain categories of patients. Please contact your doctor for more information.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/paedsurg_laparoscopicgastrostomy_0321_chi.pdf