Laparoscopy, surgical; gastrostomy, without construction of gastric tube (eg, Stamm procedure) (separate procedure)
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; gastrostomy, without construction of gastric tube (e.g., Stamm procedure)
Common name(s): Laparoscopic gastrostomy, Stamm gastrostomy.
Summary
A laparoscopic gastrostomy involves creating an opening (stoma) in the stomach through the abdominal wall using minimally invasive surgical techniques. Unlike some gastrostomy procedures, this one does not include the construction of a gastric tube.
Purpose
This procedure is used to provide a means for feeding directly into the stomach, bypassing the mouth and esophagus. It is commonly performed when a patient is unable to take sufficient nutrition orally due to conditions like swallowing disorders, cancer, or neurological impairments.
Indications
- Severe dysphagia (difficulty swallowing)
- Neurological disorders (e.g., stroke, ALS)
- Head or neck cancers that obstruct normal feeding
- Malnutrition due to an inability to consume enough food orally
Preparation
- Patients are usually required to fast for at least 8 hours before the procedure.
- Adjustments to medications, particularly blood thinners, may be necessary.
- Pre-procedure assessments might include blood tests and imaging studies.
Procedure Description
- The patient is placed under general anesthesia.
- Several small incisions are made in the abdominal wall.
- A laparoscope (a thin tube with a camera) is inserted through one of the incisions to guide the procedure.
- Special surgical instruments are used to create a small opening in the stomach.
- The stomach is sutured to the abdominal wall to create a stoma.
- A feeding tube is typically placed through this new opening.
- The incisions are closed with sutures or surgical staples.
Duration
The procedure typically takes about 1-2 hours.
Setting
The procedure is usually performed in a hospital operating room or a surgical center with specialized facilities.
Personnel
- Surgeon
- Anesthesiologist
- Surgical nurses
- Possibly a gastroenterologist
Risks and Complications
Common risks include:
- Infection
- Bleeding
- Injury to surrounding organs Rare complications might include:
- Peritonitis (inflammation of the peritoneum)
- Dislodgement of the feeding tube
- Stomal leakage
Benefits
- Improved nutritional intake
- Reduction in aspiration risk
- Enhanced quality of life through better nutrition and weight maintenance Benefits can typically be realized shortly after recovery from surgery.
Recovery
- Patients may need to stay in the hospital for a few days post-procedure.
- Instructions for care of the gastrostomy site will be provided.
- Feeding through the tube usually starts gradually and under medical supervision.
- Full recovery can take several weeks, and patients may need follow-up appointments to monitor healing and functionality.
Alternatives
- Percutaneous endoscopic gastrostomy (PEG)
- Nasogastric (NG) tube feeding
- Parenteral nutrition (IV feeding) PEG is less invasive but may not be suitable for all patients, while NG tubes are less permanent and parenteral nutrition does not use the digestive tract.
Patient Experience
- During the procedure: The patient will be under general anesthesia and should not feel any pain.
- After the procedure: Some discomfort and pain at the incision sites, managed with pain relief medications.
- Adjustment to the feeding tube and care for the gastrostomy site will be necessary, with support and education from healthcare providers.