Name of the Procedure:

Closure of gastrostomy, surgical
Common name(s): Surgical removal of gastrostomy tube, Gastrostomy site closure
Medical term: Gastrostomy closure

Summary

Surgical closure of gastrostomy is a procedure to remove a gastrostomy tube and close the site where the tube was inserted into the stomach. The gastrostomy tube, initially placed to provide nutrition directly to the stomach, is no longer necessary and is surgically removed.

Purpose

This procedure addresses the need to permanently close a gastrostomy site, often due to the patient no longer requiring direct nutritional support through a gastrostomy tube. The main goal is to properly close the opening, prevent infection, and allow the stomach and abdominal wall to heal.

Indications

• No longer needing direct nutritional support through a gastrostomy tube
• Adequate oral intake restored
• Complications at the gastrostomy site such as infection, leakage, or discomfort
• Improvement of the underlying medical condition that initially required gastrostomy

Preparation

• Patients may be advised to fast for 6-8 hours before the procedure
• Certain medications, particularly blood thinners, may need to be paused as directed by the healthcare provider
• Pre-procedure blood tests or imaging may be needed to evaluate overall health and gastrostomy site condition

Procedure Description

1. The patient is typically administered general anesthesia to ensure they are unconscious and pain-free.
2. The surgical team cleans the area around the gastrostomy tube.
3. The procedure involves removing the gastrostomy tube.
4. The surgeon then closes the opening in multiple layers, including the stomach and abdominal wall, to ensure proper healing.
5. Sutures are used to close the external incision.

Duration

The surgical closure of a gastrostomy typically takes about 1 to 2 hours, depending on the complexity of the case.

Setting

This procedure is typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or injury to surrounding organs
• Adverse reactions to anesthesia
• Development of fistula (abnormal connection) between the stomach and the abdominal wall
• Scar tissue formation

Benefits

• Removal of the unnecessary gastrostomy tube
• Proper healing and closure of the gastrostomy site
• Reduced risk of infection or leakage in the gastrostomy area
• Improvement in comfort and quality of life

Recovery

• Monitoring in a recovery room immediately after the surgery
• Pain management with prescribed medications
• Instructions for wound care to keep the site clean and dry
• Gradual reintroduction of normal activities over a few weeks
• Follow-up appointments to monitor healing and remove sutures, if necessary

Alternatives

• Non-surgical removal if the tube falls out naturally and the site can heal on its own (rare and not recommended if the gastrostomy has been in place for long)
• Maintaining the gastrostomy tube if there is any potential future need for direct gastric feeding, although this is uncommon

Patient Experience

Patients can expect to be unconscious during the procedure due to general anesthesia. Discomfort and pain at the surgical site are common post-procedural experiences and can be managed with prescribed medications. Over time, patients typically feel better as healing progresses. Immediate concerns should be communicated to the healthcare provider, especially signs of infection, excessive pain, or leakage.