Fig. 1
Endoscopy for percutaneous endoscopic gastrostomy tube placement (Source: Bryan Walters and Christopher Coppola)
3.
Open Gastrostomy should be considered if there are contraindications for a PEG or if abdomen is open for another procedure.
(a)
An abdominal incision adequate to identify the stomach and suture it to the abdominal wall is made. Create the incision far enough from the gastrostomy tube to allow adequate healing.
(b)
Incision for the tube is planned to provide a comfortable tube position without tension or twisting of the stomach, typically between the left costal margin and the umbilicus.
(c)
The mid anterior gastric wall is grasped with a Babcock forceps, and positioning is tested. Two concentric purse-string sutures are placed in the mid anterior wall of the stomach. A gastrotomy is created in the center of the purse string sutures.
(d)
A gastrostomy tube is introduced into the stomach and balloon is inflated. Caution is taken to not overinflate balloon and obstruct distal stomach.
(e)
The gastric wall is anchored to the inside of the abdominal wall to approximate gastric incision with the abdominal wall. Caution must be taken to not puncture the balloon while placing anchoring sutures.
(f)
The abdominal incision is closed and the gastrostomy tube is anchored to the skin, taking care to not puncture the balloon.
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