Assessment of safety and feasibility of a new technical variant of gastropexy for percutaneous endoscopic gastrostomy: an experience with 435 cases

Abstract

Background: Percutaneous Endoscopic Gastrostomy (PEG) performed through the Introducer Technique is associated with lower risk of surgical infection when compared to the Pull Technique. Its use is less widespread as the fixation of the stomach to the abdominal wall is a stage of the procedure that is difficult to be performed. We present a new technical variant of gastropexy which is fast and easy to be performed. The aim of this study was to evaluate the safety and feasibility of a new technical variant of gastropexy in patients submitted to gastrostomy performed through the Introducer Technique.

Methods: All the patients submitted to PEG through the Introducer Technique were evaluated using a new technical variant of gastropexy, which consists of two parallel stitches of trasfixation sutures involving the abdominal wall and the gastric wall, performed with a long curved needle. Prophylactic antibiotics were not used. Demographic aspects, initial diagnosis, indication, sedation doses, morbidity and surgical mortality were all analyzed.

Results: Four hundred and thirty-five consecutive PEGs performed between June 2004 and May 2007 were studied. Nearly all the cases consisted of patients presenting malignant neoplasia, 79.5% of which sited in the head and neck. The main indication of PEG was dysphagia, found in 346 patients (79.5%). There were 12 complications (2.8%) in 11 patients, from which only one patient had peristomal infection (0.2%). There was one death related to the procedure.

Conclusion: Gastropexy with the technical variant described here is easy to be performed and was feasible and safe in the present study. PEG performed by the Introducer Technique with this type of gastropexy was associated with low rates of wound infection even without the use of prophylactic antibiotics.

Figure 1

Suture method. Transfixation suture with curved needle involving the abdominal and the gastric wall, performed under endoscopic guidance (Figures 1a, b and 1c). A second transfixation U-shaped stitch was employed in parallel with the first one (Figure 1d).

Figure 2

Gastric tube introduction technique – abdominal wall path. A cutaneous incision was made between the two stitches (Figure. 2a) and afterwards a path was made through the abdominal wall by using Metzenbaum scissors without puncturing the gastric wall (Figure. 2b).

Figure 3

Gastric tube introduction technique – trocar puncture and gastric tube introduction. The gastric wall was punctured with a trocar introducer with a peel-away sheath (Figure. 3a and 3b), the G-tube was introduced through the sheath (Figure. 3c), the balloon was then inflated and the sheath was removed (Figure. 3d).

Figure 4

Distribution of patients referred for PEG.