Role Of Gastrostomy Research Articles

Role of gastrostomy in nutritional care

Role of gastrostomy in nutritional care

The role of gastrostomy in the staged operation of esophageal atresia

Introduction:The aim of this study is to recommend criteria for selection of patients who benefited from the use of gastrostomy rather than emergency fistula closure during the staged operation of esophageal atresia (EA).Materials and Methods:Between August 2004 and July 2006, 75 cases of EA, were consecutively operated. Nineteen out of 75 (25%) underwent routine gastrostomy because they required a type of staged operation: Group I: Five cases with pure atresia had gastrostomy and esophagostomy; Group II: Six with severe pneumonia and congenital heart disease (Waterson class C) had gastrostomy and conservative management; Group III: Eight with long gap EA (2-4 vertebras); four out of 8 cases underwent primary anastomosis with tension and the other four had delayed primary anastomosis plus primary gastrostomy.Results:GI: Only three cases survived after esophageal substitution; GII: Three out of six cases with severe pneumonia (fistula size: f > 2.5 mm) underwent emergency fistula closure with only one survival, but all (f < 2.5 mm) recovered without complication, GIII: Four patients with long gap and primary anastomosis with tension developed anastomotic leakage; they required gastrostomy following the leakage, except for those with delayed primary anastomosis, and all of them recovered without early complications.Conclusion:All the cases with long gap, although two esophageal ends can be reached with tension, should undergo delayed primary closure with primary gastrostomy. Those were brought with Waterson class C and the fistula size greater than 2.5 mm should undergo emergency fistula closure; however, if fistula size was less than 2.5 mm, it is better to be delayed by primary gastrostomy for stabilization. In this study, we had a better outcome with gastric tube for substitution than colon interposition in infants.

Infantile pyloric stenosis associated with major anomalies of the alimentary tract

Five cases of infantile pyloric stenosis, three associated with esophageal atresia and tracheoesophageal fistula, one with Hirschsprung's disease and one with exomphalos are described. The etiologic factors, especially the role of gastrostomy, in the apparently higher incidence of pyloric stenosis in babies with alimentary tract anomalies are discussed. The diagnosis of pyloric stenosis may be difficult in these circumstances because of the absence of, or difficulty in, eliciting the usual signs. Clinical signs often being inconclusive, radiologic studies must be performed in all suspected cases. Five cases of infantile pyloric stenosis, three associated with esophageal atresia and tracheoesophageal fistula, one with Hirschsprung's disease and one with exomphalos are described. The etiologic factors, especially the role of gastrostomy, in the apparently higher incidence of pyloric stenosis in babies with alimentary tract anomalies are discussed. The diagnosis of pyloric stenosis may be difficult in these circumstances because of the absence of, or difficulty in, eliciting the usual signs. Clinical signs often being inconclusive, radiologic studies must be performed in all suspected cases.