Operating gastrostomy tubes: Insertion and removal for minimally invasive transgastric ulcer surgery

Summary

Some patients with bleeding peptic ulcer either continue to bleed or rebleed following endoscopic interventional therapy. Open surgery may be the only method capable of arresting haemorrhage. This requires a general anaesthetic and laparotomy. Many patients are elderly and have concomitant medical problems placing them at increased risk from surgery. A less invasive method for gaining access to the gastric cavity may benefit these patients.

Operating gastrostomy tubes (a laparoscopic port attached to a gastrostomy tube) were placed through the anterior abdominal wall directly into a porcine stomach. This allowed both visual and operative access anywhere in the stomach, apart from the pyloric canal. 20 experimental bleeding ulcers were created and complete haemostasis was achieved by under-running with laparoscopic equipment. Operating gastrostomy ports were removed and the resulting gastrostomy closed using a new percutaneous method. No infection or fistula formation occurred following gastrostomy removal.

This is a minimally invasive method for gaining access to the gastric cavity with laparoscopic equipment, enabling surgical procedures to be performed. Insertion and removal of operating gastrostomy ports may be able to be performed under a local anaesthetic and sedation, which may allow some transgastric surgical procedures to be performed without a general anaesthetic.

Keywords:

• gastrostomy tubes
• laparoscopic ports
• minimally invasive surgery
• bleeding peptic ulcers