Abstract
BackgroundGastrostomy placement is the preferred means of long-term enteral feeding for patients who cannot eat by mouth. During laparoscopic gastrostomy, it is standard to perform gastropexy, apposing visceral and parietal peritoneum. In some settings, due to altered anatomy from prior surgery, direct apposition of the stomach to the abdominal wall is not possible. This study reports a series of cases where laparoscopic gastrostomy was performed via a Witzel approach without gastropexy.MethodsA retrospective chart review was performed of all patients at a tertiary academic medical center who underwent Witzel gastrostomy without gastropexy over a 3-year period. In each case, an 18-French tube was placed into the fundus of the stomach and secured with a purse-string suture. A 5-cm serosalized Witzel tunnel was created around the tube using running silk suture. No gastropexy was performed.ResultsSix patients underwent 7 Witzel gastrostomy procedures. In three cases, patients had undergone prior major upper abdominal surgery where adhesive disease prevented gastropexy. In the other four cases, the patients had undergone prior gastric bypass with antecolic antegastric position of the roux limb. No patient suffered leak of gastric contents into the peritoneum, and there were no postoperative complications or mortality related to the gastrostomy.ConclusionIn cases where enteral access is necessary, and where the stomach cannot reach the anterior abdominal wall for gastropexy due to prior surgeries, a Witzel gastrostomy without gastropexy is a safe option which resulted in no morbidity or mortality in our series.
Highlights
Enteral nutritional access is the preferred means of delivering nutrition to patients who require prolonged supplementation
While prior abdominal surgery was initially considered a contraindication to percutaneous endoscopic gastrostomy (PEG), several authors have reported PEG to be a safe procedure even in those who have undergone major abdominal surgery [4, 5]
The aim of the current study is to describe a novel technique of laparoscopic “Witzel” gastrostomy without gastropexy as a means of gastrostomy placement when the stomach cannot reach the abdominal wall
Summary
Enteral nutritional access is the preferred means of delivering nutrition to patients who require prolonged supplementation. While prior abdominal surgery was initially considered a contraindication to PEG, several authors have reported PEG to be a safe procedure even in those who have undergone major abdominal surgery [4, 5] In some patients, such as those who have undergone upper abdominal surgery or gastric surgery, including gastric bypass, anatomical limitations or significant adhesive disease prevent safe percutaneous access to the stomach. Due to either extensive adhesive disease or the presence of an antecolic antegastric roux limb, the stomach or remnant stomach will not reach the abdominal wall, precluding laparoscopic, open, or percutaneous gastrostomy In such patients, a jejunal feeding tube may be placed in lieu of a gastric feeding tube.
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