• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Laparoscopic Janeway Permanent Gastrostomy

First submitted by:
Shawn Tsuda
Category
Stomach and Foregut
Print Friendly, PDF & Email

Laparoscopic Janeway Permanent Gastrostomy

A permanent gastrostomy may be appropriate for patients who have no prospect of being able to feed themselves orally.  The laparoscopic approach to a gastrostomy may allow for the advantages of decreased pain, hospital stay, and convolescent period in patients who usually have significant comorbidities already.

 

Preoperative Preparation and Operating Room Setup

Patients should have sequential compression stockings and subcutaneous heparin or low-molecular-weight heparin should be considered perioperatively. Prophylactic antibiotics are give 30 min prior to incision.  A foley catheter can be placed and a nasogastric tube to decompress the stomach is recommended.

The patient is placed in the supine position. The surgeon stands on the patient’s left and the assistant on the right.  Dual monitors should be positioned at the head of the bed. A basic laparoscopic tray including straight and/or angled laparoscopes, atraumatic graspers, and dissectors should be present, as well as a basic open procedural tray.

 

Port Placement

The initial trocar is placed in a infraumbilical position either with an open cut-down technique, an optical trocar, or pre-insufflation with a Veress needle followed by trocar placement, optical or not. A survey of the abdomen can assess the abdominal wall for any adhesions that may obstruct safe port placement. Two 5 mm ports are placed lateral to the midclavicular lines on the left and right, between 15 and 20 cm from the costal margins, usually above the umbilicus. A 12 mm trocar is placed at a site appropriate to wear the greater curvature of the stomach is grasped and easily brought up to the abdominal wall for eventual externalization.

 

Creation of Gastric Diverticulum

Through the 12 mm port, a 60 mm endoscopic stapler is used to create a gastric diverticulum along the greater curvature

 

Maturation of Gastric Diverticulum and Placement of Gastrostomy Tube

An atraumatic grasper is used to grasp the diverticulum and externalize it through the 12 mm port site.  Care should be taken to assure there is no tension on the diverticulum as it approaches the skin.  The end of the diverticulum is opened with an energy device and the edges approximated to the skin with interrupted 3-0 vicryl or other absorbable suture.  A balloon-tipped gastrostomy tube or foley catheter of at least 24 Fr diameter is placed into the gastric lumen and the balloon inflated and secured to the abdominal wall.

 

Ports are removed under direct visualization after final survey of the abdomen for bleeding or injury, and skin incisions closed with sutures or surgical glue.  Any 12 mm trocar sites should be closed at the fascial level.

 

Postoperative Care

Feedings can be started within 24 hours of the permanent gastrostomy creation.  Care should be taken to secure the gastrostomy carefully, and to flush it frequently with water to avoid clogging.

 

References

1. Duh QY, Senokozlieff AL, Choe YS, Siperstein AE, Rowland K, Way LW. Laparoscopic gastrostomy and jejunostomy. Arch Surg. 1999;134:151-156.
2. Wu J, Soper NJ, Gastrostomy and jejunostomy. In: Jones DB, Wu J, Soper NJ, eds. Laparoscpoic Surgery: Principles and Practice. New York: Marcel Dekker;2004:219-241.

4,500

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Category: Stomach and Foregut
  • Main Page
  • Help
  • Create a New Wiki

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons