OPERATING GASTROSTOMY TUBES - INSERTION AND REMOVAL FOR MINIMALLY INVASIVE TRANSGASTRIC ULCER SURGERY

Some patients with bleeding peptic ulcer either continue to bleed or r ebleed following endoscopic interventional therapy. Open surgery may b e the only method capable of arresting haemorrhage. This requires a ge neral anaesthetic and laparotomy. Many patients are elderly and have c oncomitant medical problems placing them at increased risk from surger y. A less invasive method for gaining access to the gastric cavity may benefit these patients. Operating gastrostomy tubes (a laparoscopic p ort attached to a gastrostomy tube) were placed through the anterior a bdominal wail directly into a porcine stomach. This allowed both visua l and operative access anywhere in the stomach, apart from the pyloric canal. 20 experimental bleeding ulcers were created and complete haem ostasis was achieved by under-running with laparoscopic equipment. Ope rating gastrostomy ports were removed and the resulting gastrostomy cl osed using a new percutaneous method. No infection or fistula formatio n occurred following gastrostomy removal. This is a minimally invasive method for gaining access to the gastric cavity with laparoscopic equ ipment, enabling surgical procedures to be performed. Insertion and re moval of operating gastrostomy ports may be able to be performed under a local anaesthetic and sedation, which may allow some transgastric s urgical procedures to be performed without a general anaesthetic.