China
Africa
Explore chapters and articles related to this topic
Gastrostomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Alejandra M. Casar Berazaluce, Aaron P. Garrison, Todd A. Ponsky
The primary placement of GJ-tubes is becoming more common. With just minor modifications from a standard gastrostomy, they can help temporarily avoid fundoplication. Available as an image-guided percutaneous procedure performed by interventional radiologists, GJ-tubes can be inserted in patients with factors that are prohibitive for endoscopic access or general anesthesia. After the gastric lumen is identified with fluoroscopy, CT scan, or ultrasound, gastropexy is accomplished with T-fasteners. Gastric puncture is accomplished with the needle aimed toward the pylorus to allow passage of a rigid catheter into the duodenum through which a guidewire is passed beyond the ligament of Treitz under fluoroscopic guidance. The skin tract is dilated in a similar way to other percutaneous techniques, and a GJ-tube catheter is inserted over the guidewire with position in the proximal jejunum confirmed with contrast administration.
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
If the problem is causing symptoms then surgical treatment is the only satisfactory approach. Traditionally, open surgery has been employed but this problem is suitable for laparoscopic treatment if appropriate skill is available. If there is a hernia, the sac and its contents (usually the stomach) should be reduced. The defect in the diaphragm should be closed, if necessary, with a mesh. It is advisable to separate the stomach from the transverse colon and then perform an anterior gastropexy to fix the stomach to the anterior abdominal wall. The results from this treatment are good.
Gastro-oesophageal reflux disease
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Which of the listed procedures corresponds to the descriptions below? Involves a 360-degree wrap of the oesophagus.A partial 180-degree anterior wrap with fixation of the remaining fundus to the left hemidiaphragm.Partial wrap (180- to 270-degree) passed posterior to the oesophagus.Partial anterior wrap, often favoured in GORD in oesophageal atresia.Involves detaching stomach from oesophagus and restores continuity with a Roux loop.Is an anterior gastropexy.Is a posterior gastropexy.Correction of a hiatus hernia accomplished by closure of the oesophageal orifice with three tight sutures after retraction of the stomach into the abdomen and reconstruction of the angle of His.
A rare cause of severe epigastric pain, emesis and increased lipase
Published in Acta Chirurgica Belgica, 2018
Daan Van Olmen, Francis Somville, Gerry Van der Mieren
After stabilization and if decompression and reduction of the volvulus was not successful by the placement of nasogastric tube or endoscopy, urgent surgery is necessary [1–3]. Laparoscopic or open surgery is executed to derotate the stomach and reobtain normal anatomy by repairing underlying hernias or anatomical defects in case of secondary gastric volvulus or re-attach the stomach by gastropexy.
Technique and outcome of percutaneous endoscopic transgastric jejunostomy for continuous infusion of levodopa-carbidopa intestinal gel for treatment of Parkinson’s disease
Published in Scandinavian Journal of Gastroenterology, 2019
Yuji Ishibashi, Yasushi Shimo, Yukinori Yube, Shinichi Oka, Hiroki Egawa, Yoshinori Kohira, Sanae Kaji, Satoshi Kanda, Genko Oyama, Taku Hatano, Nobutaka Hattori, Tetsu Fukunaga
Severe peritonitis should be considered a medical emergency. The incidence of peritonitis after PEG-J performed for LCIG therapy (0–13.5%) is higher than that after PEG performed for feeding purposes (0.5–1.3%) [5–13,24]. The peritonitis may result from the technique used to advance the J-tube, repeated attempts at placing the tube in the optimal position, and/or early post-operative ‘in-and-out’ movement of the tube. Taping the PEG tube and/or J-tube flush to the abdominal wall immediately after placement may increase the lateral tension exerted on the tube(s), increasing the risk of peritonitis [5]. The increased incidence of peritonitis among PD patients may be due to these patients’ mobility and activity, resulting in inadvertent pulling on the tube. To prevent peritonitis, we performed gastropexy in all cases. Gastropexy formation postulated advantages include fixation of abdominal wall and the anterior stomach wall while dilating the gastrostomy tract and inserting the gastrostomy tube and secondly, the prevention of fluid leakage and peritonitis. With gastropexy, the abdominal wall and stomach are fixed tightly, and the gastrostomy tract matures rapidly, so gastropexy prevents peritonitis [25–27]. With the pull method, gastropexy is not essential, and so the necessity of gastropexy remains controversial. However, Okumura and colleagues reported that, in comparison to non-performance of gastropexy, gastropexy performed along with the pull method reduced the incidence of complications, including peritonitis and peristomal infection [27]. The disadvantages of gastropexy are procedural complexity, added procedure time, and possible local complications. We note, however, that our median procedure time (26.4 minutes) was not long in comparison to the time reported elsewhere (31 minutes) [6], and we did not encounter gastropexy-related complications. Although the pain and skin excoriation associated with gastropexy are undesirable, these are relatively minor complications that resolve when the gastropexy suture threads are removed. We believe gastropexy is essential when PEG-J is performed in PD patients. Tsuboi et al. reported development of peritonitis after PEG-J performed for LCIG treatment, despite use of gastropexy [28]. In their patient, the gastropexy suture threads were removed on day 7 after PEG-J, and the peritonitis manifested on day 9. Therefore, we do not remove the gastropexy sutures until 2 weeks after PEG-J.