purse-string gastrostomy

Gastrostomy is to establish a pathway to the outside of the stomach between the anterior wall of the stomach and the anterior abdominal wall to solve the nutritional problems of some patients. There are many methods for gastrostomy, but the total is divided into temporary gastrostomy and permanent gastrostomy. It can be selected according to the patient's disease nature and prognosis. Treating diseases: esophageal cancer Indication 1. Esophageal cancer can not be surgically removed, can be used as a symptom relief surgery. It is estimated that the survival period is longer than 3 months, and permanent gastrostomy may be feasible; if the survival time is shorter than 3 months, temporary gastrostomy is performed. 2. In patients with benign esophageal stricture, temporary gastrostomy may be performed as a preparatory operation to facilitate subsequent thorough surgery or dilatation treatment. 3. Some patients with special abdominal surgery, postoperative temporary gastrostomy, early decompression, can be used later to feed, help patients recover. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation Patients with esophageal obstruction can not eat for a long time before surgery. They are often malnourished. They must be fully infused and transfused to correct dehydration and anemia, improve nutrition, enhance tolerance to surgery and ensure wound healing. Surgical procedure Pitch-type gastrostomy is the simplest type of temporary gastrostomy. The patient is supine, generally with a left upper transabdominal rectus incision, about 6 ~ 8cm long. The upper mid-abdominal incision can also be used, and the ostomy tube can be extracted from the side of the lateral abdominal wall. After entering the abdominal cavity, the pyloric incision is selected to be the position of the anterior wall of the stomach between the left and the large and small bends. Use 2nd wire to make 2~3 layers of concentric purse stitching. The innermost layer should be 1.5cm in diameter and the spacing of each layer should be about 1cm. The stomach wall is cut at the center of the purse suture, and the incision should correspond to the diameter of the catheter to be inserted. Insert the F20 ~ 24 catheter from the incision of the stomach wall (preferably with a fistula tube or balloon catheter is not easy to escape); if using a common catheter, it is best to insert 3 ~ 5cm into the stomach cavity. Then, the inner layer begins to tighten the purse string and ligation one by one, and the catheter is buried in the stomach. The end of the catheter is drawn through the outer edge of the rectus abdominis and a small opening under the assist margin. The peritoneum around the stomach wall of the fistula and the perforation of the abdominal wall were sutured with two needles. Finally suture the abdominal wall incision.