Gastrostomy
A gastrostomy is the creation of an artificial external opening into the stomach for nutritional support or gastric decompression.
Typically this would include an incision in the patient's epigastrium as part of a formal operation. When originally devised over a century ago the procedure was completed through open surgery using the Stamm technique. It can be performed through surgical approach, percutaneous approach by interventional radiology, percutaneous endoscopic gastrostomy or percutaneous ultrasound gastrostomy.
A gastrostomy may be required due to illness, trauma or disability impacting upon the ability to eat or swallow safely, or conditions causing increased nutritional requirement and once formed, a gastrostomy tube is inserted.
Techniques
The Stamm gastrostomy is an open technique, requiring an upper midline laparotomy and gastrotomy, with the catheter brought out in the left hypochondrium. It was first devised in 1894 by the American Gastric Surgeon, Martin Stamm, who was educated greatly in surgery when he visited Germany.Over the last three decades less invasive approaches such as percutaneous endoscopic gastrostomy and laparoscopic assisted Stamm gastrostomy have become increasingly popular.
Conventional PEG involves inserting the primary feeding device through the mouth and extracting it through a small incision formed through the abdomen.
Apparent benefits of PEG include shorter operative times and reduced financial cost.