Clinical observations of minimal gastrostomy through minilaparotomy in palliative patients

Gastrostomy is used to feed palliative patients with dysphagia. Currently, the preference is given to percutaneous puncture methods of gastrostomy, which do not require general anesthesia. Percutaneous puncture techniques are possible only if the patency of the upper parts of the digestive tract still exists for the «pull method» and can require additional X-ray irradiation in case of the «push method». These operations require expensive disposable kits, which affects the prevalence and availability of the technique. Therefore, the use of an alternative minimally invasive gastrostomy through minilaparotomy is justified. Minimal-invasive pressure gastrostomy is known for a long time, and in combination with small access, it can be successfully used to provide nutrition for palliative patients with dysphagia. Most patients with dysphagia have a thin anterior abdominal wall, which allows using minimal access. It is important to choose the right place of the incision so that access is in the area of the formation of the fistula. To obtain additional diagnostic information one can use a radiography of the abdominal cavity, which shows the gas bubble of the stomach, and other high-tech methods: ultrasound, spiral computed tomography, etc. At the same time such patients do not require general anesthesia, it is possible to perform the operation under a local anesthesia. The article provides a detailed description of the technique of minimal invasive laparotomy gastrostomy and two clinical observations of palliative patients who underwent this operation.

1. Gavshchuk MV, Gostimsky AV, Bagaturiya GO, Lisovskii OV, Zavyalova AN, Karpatskii IV, et al. Import substitution possibilities in palliative medicine. Pediatr (Sankt-Peterburg). 2018; 9(1): 72-76. (In Russ.). doi: 10.17816/PED9172-76

2. Gavshchuk MV, Lisovskii OV, Gostimskii AV, Naidenov AA, Zavyalova AN, Petrosian AA, et al. Surgical methods of dysphagia correction in adult palliative patients according to the data of the compulsory health insurance system. Medicine and Health Care Organization. 2021; 6(2): 21-26. (In Russ.).

3. Khizha VV, Bogodyazh EG, Gutneev VV, Korolev MP, Skryabin ON, Popov SV. Medico-statistical indicators of medical care for residents of St. Petersburg for malignant neoplasms of the stomach in 2015–2017. Materialy IV Peterburgskogo mezhdunarodnogo onkologicheskogo foruma «Belye nochi 2018». 2018; 1: 241. (In Russ.).

4. Littmann I. Abdominal surgery; 4th ed. Budapest: Publishing House of the Hungarian Academy of Sciences; 1970. (In Russ.).

5. Drobyazgin EA, Sudovikh IE, Chikinev YuV. Percutaneous endoscopic gastrostomy in the practice of a multidisciplinary hospital. Endoscopic Surgery. 2018; 25(5): 29-31. (In Russ.).

6. Bulygin LG, Aria NR, Adiev RF, Safonov OG, Nasibullin IM. Development of permanent fissured gastric fistula method. Bashkortostan Medical Journal. 2014; 9(4): 69-71. (In Russ.).

7. Belevich VL, Strukov EYu, Brednev AO, Ovchinnikov DV. Transcutaneous endoscopic gastrostomy – the method of choice for long-term enteral feeding. Novosti Khirurgii. 2014; 22(6): 750754. (In Russ.).

8. Mumladze RB, Rozikov YSh, Deev AI, Korzheva IYu. Percutaneous endoscopic gastrostomy and its advantages in comparison with other types of stomies to perform enteral feeding. Russian Journal of Surgery. 2011; 3: 36-40. (In Russ.).

9. Bagnenko SF, Vashetko RV, Verbitsky VG, Goltsov VR, Demko AE, Karpova EA, et al. Surgical problems of emergency gastroenterology. Moscow: Heroica and Sport; 2009. (In Russ.).