Gastrostomy

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 (1847–1918), who was educated greatly in surgery when he visited Germany.

Over the last three decades less invasive approaches such as percutaneous endoscopic gastrostomy (PEG) 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.

Complications

Severe complications for gastrostomy formation classify as Clavien-Dindo grade 3 and above, requiring surgical or radiological interventions with potential morbidity and mortality. These complications may occur due to damage to surrounding structures intra-operatively, issues affecting the immature gastrostomy early post-operatively, or be secondary to device or site complications, including: adjacent bowel injury, gastrocolic fistulae, migration of gastrostomy to ribs, and failure for spontaneous closure when gastrostomy no longer needed (persistent gastrocutaneous fistula).

References

References

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5. [[:de:Martin Stamm]]
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13. (2002-03-01). "Evaluation of Laparoscopy-Assisted Percutaneous Gastrostomy Tube Placement in Children". Pediatric Endosurgery & Innovative Techniques.
14. (December 2018). "Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis". Pediatric Surgery International.
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16. (May 2018). "Gastrocutaneous fistulae in children - A systematic review and meta-analysis of epidemiology and treatment options". Journal of Pediatric Surgery.