Joshua Davies, MD, Luise Pernar, MD, Brian Carmine, MD, Donald Hess, MD, Cullen Carter, MD. Boston Medical Center
INTRODUCTION: Gastrostomy 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. However, in some settings, such as the presence of an antecolic roux limb from prior gastric bypass, gastropexy is not possible. This study reports a series of cases where gastrostomy was performed via a witzeled approach without gastropexy.
METHODS AND PROCEDURES: A retrospective chart review was performed of all patients at a tertiary academic medical center who underwent witzeled gastrostomy without gastropexy over a three year period. In each case, an 18 French feeding tube was brought through the abdominal wall and placed into the fundus of the stomach and secured with a pursestring suture. A 5cm serosalized witzel tunnel was created around the tube using running silk suture. No gastropexy was performed, and no drain was placed in any case.
RESULTS: Between September 1, 2015 and August 1, 2018, 6 patients underwent 7 witzeled gastrostomy procedures. The patients ranged in age from 39 to 86. 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. Indications for procedure were dysphagia in two cases, critical illness in one, chronic nausea and malnutrition after gastric bypass in three cases, and perforated marginal ulcer in one case. No patient suffered leakage of gastric contents into the peritoneum, and there were no postoperative complications or mortality related to the gastrostomy procedure.
CONCLUSION: In cases where enteral access is necessary, and where the stomach cannot reach the anterior abdominal wall for gastropexy due to prior surgeries, a witzeled gastrostomy without gastropexy is a safe option, and in this small series resulted in no morbidity or mortality.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94660
Program Number: P052
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster