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Operative Procedure Usually, a gastrostomy is placed as part of another intra-abdominal procedure. Currently, most gastrostomies are performed using the percutaneous endoscopic technique. Stamm Gastrostomy The body of the stomach is grasped with two Babcock clamps. An inner purse-string suture of absorbable suture is placed, followed by a n outer purse-string suture using silk Fig.
The adjacent linea alba is grasped with Kocher clamps, and with a no. A long Schnidt clamp is passed through this stab incision into the peritoneal cavity under direct vision. Using this Schnidt clamp as a guide, a similar clamp is passed from the peritoneum outward through the same incision. An 18 Fr Foley catheter or a gastrostomy tube is drawn through the anterior abdominal wall using the Schnidt clamp.
With electrocautery, a gastrotomy is made in middle of the previously placed inner purse-string suture, and the tip of the Foley catheter is inserted into the stomach. The balloon is inflated with 10 to 20 mL of water, and the purse-string sutures are snugly tied down. B, The second, outer purse-string suture is tied. The gastrostomy tube is secured to the anterior abdominal wall at four quadrants with the silk suture Fig. The gastrostomy tube is flushed with saline. The tube can be secured to the skin with a nylon suture.
C, Cross-section shows the gastrostomy tube being brought out through the anterior abdominal wall, and the anterior stomach wall is sutured to the peritoneum,. Janeway Gastrostomy This procedure involves creation of a small, permanent gastric tube using the anterior wall of the stomach.
The midportion of the anterior wall of the stomach is grasped with two Babcock clamps and drawn upward. A GIA linear stapler is applied to the serosal surface of the stomach with the tips of the forks about 3 cm from the greater curvature. The instrument is closed and fired, creating an approximately 4- to 5-cm gastric tube. For additional security, the staple line is inverted with interrupted silk sutures, taking care to avoid narrowing the lumen of the tube.
The gastric tube is brought out through a stab wound in the anterior abdominal wall. The gastric tube is secured on the undersurface of the anterior abdominal wall at four corners using silk sutures. The tip of the gastric tube is transected and then matured by placing interrupted mucocutaneous absorbable sutures.
The gastric tube can be tested by gently passing a Foley catheter through it. The midline incision is closed in the standard fashion by approximating the linea alba with continuous polypropylene monofilament sutures. The subcutaneous tissue is irrigated, and the skin is approximated with staples. Learn more about Scribd Membership Home. Much more than documents. Discover everything Scribd has to offer, including books and audiobooks from major publishers.
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Is this content inappropriate? Report this Document. Description: tecnica quirurgica. Flag for Inappropriate Content. Download Now. Related titles. Carousel Previous Carousel Next. Jump to Page. Search inside document. C, Cross-section shows the gastrostomy tube being brought out through the anterior abdominal wall, and the anterior stomach wall is sutured to the peritoneum, Janeway Gastrostomy This procedure involves creation of a small, permanent gastric tube using the anterior wall of the stomach.
CLOSURE The midline incision is closed in the standard fashion by approximating the linea alba with continuous polypropylene monofilament sutures. Documents Similar To gastrostomia. Leslie Samuel. Diana Montes. Rtr Ram Transformed Ram. Bio Sciences. Chai Cosme. Jaime de Bracamonte. Carmelle Zia Reyes. Anityo Nugroho. Faizan Elahi.
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Cómo Comprender la Gastrostomía Endoscópica Percutánea