Name of the Procedure:

Gastrostomy, open; with construction of gastric tube (Janeway procedure)

Summary

The open gastrostomy with construction of a gastric tube procedure, often referred to as the Janeway procedure, involves creating a permanent opening into the stomach through the abdomen. This opening allows for direct access for feeding when oral intake is not possible.

Purpose

This procedure is typically performed to help patients who cannot swallow food or fluids due to medical conditions such as esophageal cancer, severe neurological disorders, or swallowing difficulties. The main goal is to ensure the patient receives adequate nutrition and hydration directly into the stomach.

Indications

• Difficulty swallowing (dysphagia) due to neurological or muscular disorders
• Obstructions in the esophagus
• Head or neck cancers
• Severe facial trauma
• Long-term need for nutritional support

Preparation

• Fasting for 8 hours prior to the procedure
• Adjustments in medications, particularly blood thinners
• Preoperative evaluations including blood tests, imaging studies, and a thorough physical examination

Procedure Description

1. The patient is placed under general anesthesia to ensure comfort and immobility.
2. The surgeon makes an incision in the abdomen to access the stomach.
3. A segment of the stomach is carefully formed into a tube that will serve as a conduit for feeding.
4. The tube is brought out through the abdominal wall and secured in place.
5. The surgeon closes the initial incision with sutures or staples.

Duration

The procedure usually takes about 1 to 2 hours to complete.

Setting

This procedure is typically performed in a hospital operating room.

Personnel

• General surgeon or gastrointestinal surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Bleeding
• Damage to nearby organs
• Tube dislodgement or blockage
• Peritonitis (inflammation of the abdominal lining)

Benefits

• Ensures adequate nutrition and hydration
• Improves quality of life by reducing the stress related to feeding difficulties
• Can be a long-term solution to chronic feeding problems

Recovery

• Hospital stay of a few days to monitor for complications
• Pain management with prescribed medications
• Instructions on how to care for the gastrostomy tube
• Follow-up appointments to check for proper healing and tube function
• Usually, patients can resume normal activities within a few weeks, with specific dietary and activity guidelines

Alternatives

• Percutaneous endoscopic gastrostomy (PEG)
• Nasogastric tube feeding
• Jejunostomy (direct feeding into the small intestine)
• Each alternative has its own risks and benefits, which should be discussed with a healthcare provider.

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel pain.
• Postoperative pain and discomfort are managed with medication.
• Patients may experience mild discomfort or soreness at the surgical site, which will diminish over time.
• Emotional support and adequate education on managing the tube at home are crucial for adjustment and comfort.