Name of the Procedure:

Gastrostomy, open; without construction of gastric tube (e.g., Stamm procedure) (separate procedure)

Summary

An open gastrostomy is a surgical procedure in which an opening is created directly into the stomach from the outside abdomen. This allows for the insertion of a feeding tube without constructing a gastric tube. This procedure is often referred to as the Stamm procedure.

Purpose

This procedure is performed to provide a means of nutritional support for individuals who are unable to consume food orally due to various medical conditions. The main goal is to ensure that the patient can receive adequate nutrition and hydration.

Indications

• Severe difficulty swallowing (dysphagia) due to neurological conditions like stroke or ALS.
• Esophageal obstructions or cancers.
• Long-term need for nutritional support when oral intake is not possible.
• Severe cases of aspiration pneumonia.

Preparation

• Patients are typically required to fast for 8-12 hours before the procedure.
• Adjustments to certain medications may be necessary; blood thinners, for instance, may need to be discontinued.
• Pre-procedure assessments may include blood tests, and imaging studies to assess the anatomy.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the abdomen to expose the stomach.
3. The stomach is brought up to the abdominal wall, and an opening (stoma) is created.
4. A feeding tube is inserted into the created stoma and secured in place.
5. The incision is then closed, and the feeding tube is tested for proper placement.

Tools, equipment, or technology:

• Surgical instruments (scalpels, clamps, sutures)
• Feeding tube
• Anesthesia equipment

Anesthesia:

• General anesthesia is used, ensuring the patient is completely unconscious and pain-free.

Duration

The procedure typically takes 45 minutes to 1 hour.

Setting

This procedure is usually performed in a hospital surgical suite.

Personnel

• Surgeon (typically a general surgeon or specialist in gastrointestinal surgery)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Accidental injury to surrounding organs
• Dislodgement or malfunction of the feeding tube
• Long-term complications like gastric ulcers or blockages

Benefits

• Provides a reliable way to ensure the patient receives adequate nutrition and hydration.
• Can improve the patient's overall health and quality of life.
• Reduces the risk of aspiration pneumonia in patients with severe swallowing difficulties.

Recovery

• Patients may stay in the hospital for a few days post-surgery for monitoring.
• Pain management typically involves oral or IV pain relievers.
• Instructions for care of the gastrostomy tube will be provided.
• Recovery period usually lasts one to two weeks; normal activities can gradually resume within this timeframe.
• Follow-up appointments are necessary to monitor the site and assess nutritional status.

Alternatives

• Percutaneous endoscopic gastrostomy (PEG) – a less invasive option that uses endoscopy and local anesthesia.
• Nasogastric (NG) tube – a temporary solution for short-term nutritional needs.
• Parenteral nutrition – intravenous feeding for cases where gastrointestinal tract use is not feasible.

Pros and cons of alternatives:

• PEG is less invasive but may not be suitable for all patients.
• NG tubes are temporary and uncomfortable for long-term use.
• Parenteral nutrition can be effective but carries significant risks and high cost.

Patient Experience

• During the procedure, the patient will be under general anesthesia and won't feel anything.
• Post-procedure, patients might experience some pain and discomfort at the incision site.
• Pain management measures will include medication and careful monitoring.
• Feeling of fatigue and soreness is common for a few days post-surgery.