BACKGROUND: Gastrostomy for feeding or descompressive purposes are often performed transendocopically, by fluoroscopic guidance, and more rarely, by laparoscopy or by an abdominal midline incision. As endoscopic and radiologic personel and instrumental are often not wide available in community hospitals in our country, an alternative method was developed in our institution. A single-wound, surgical access gastrostomy, performed with local anesthesia and no need for endoscopic guidance, is described. METHODS: Fifteen patients elegible for gastrostomy were submitted to the technique. The patients were managed under local anesthesia, and after a 1cm incision on the left rectus abdominal muscle, an area of gastric wall is localized under Methylene Blue testing. With confirmation of gastric content, two layers of concentric purse string unabsorbable sutures are placed to work as a valve, and the stomach is fixed to the rectus sheath, resulting in a safe single wound gastrostomy. The feeding through the tube was started in 24 to 48hs. RESULTS: All patients were successfully managed by this method. Minor complications ocurred in 3 patients: one enlargement of the gastrostomy required additional suture, and one partial mucosal dehiscence was clinically managed. In a third patient, an iatrogenic transverse colon laceration ocurred, and suture closure was performed without further morbidity. Mean operative time was 49.4 min, mean institution of gastrostomy feeding was 34.3 hs. There was no failure to achieve postoperative feeding nor major complications as leakage or peritonitis. CONCLUSION: Our results suggest that this new approach is effective and safe, providing a single wound access, avoiding the need for endoscopic guidance and general anesthesia. It can also be used instead of the endoscopic method in patients with faringo-esophageal obstruction. A larger number of cases, longer follow-up observation and prospective randomized studies are needed to establish the role of the new technique in a routine basis.
Gastrostomy; Gastrostomy; Digestive system surgical procedures; Prospective studies
