Laparoscopic gastrostomy tube
Codes
Laparoscopic gastrostomy tube CPT 43653
Surgon specifics
Kaveh Vali
Technique
Grab stomach in the body, opposite the incisura
Close umbilical incision with interrupted buried dermal 4-0 Vicryl
Dressing umbilical incision with 2x2 gauze and Tegaderm
Dress G tube with several folded 2x2 gauze and large Tegaderm, making a mesentery over the tube.
Indications
Failure to thrive-child R62.51 (ICD10-CM)
Preoperative workup
The family must be willing to take care of the g tube and use it appropriately. They will have teaching postoperatively but they should be aware of what cares they will need to provide.
Surgical technique
Gain access to the abdomen. In pediatrics surgery this is usually a vertical incision through the umbilicus and then veres needle.
Mark a point half way between the umbilicus and left costal border on the mid clavicular line
Make a stab incision and dilate the tract and fascia
Grab the stomach in the body, 2/3 from the EGJ and pylorus with a grasper through this hole
Using 1 PDS on CT1 take bite starting from outside the skin, approximately 1 cm from the hole, enter the abdomen, grab full thickness stomach and then bring needle outside the abdomen and secure with clamp
Do the same thing on the other side of the hole
Introduce introducer needle into the hole, and align between the sutures
Anesthesia to inflate the stomach with air
Poke needle through the stomach
Pass wire, and then appropriate dilators
Insert the G tube and inflate balloon with water (not saline) to secure to abdominal wall
Tie down sutures loosely over the g tube
Test the tube with flushing and pulling back of gastric contents
Close the fascia at the umbilicus with 2-0 Vicryl on UR6 needle
Close umbilical incision and dress appropriately
Complications and post-op care
G tube to gravity x 6 hrs post op
Okay for meds right away
0.25% feeds after 6 hrs advance over 24 hrs, slowly
Suture will stay in for 5 days post op
Sample dictation
laparoscopic gastrostomy tube 43653
After informed consent was confirmed, the patient was taken to the operating room and placed in the supine position. Anesthesia was induced and the patient was intubated without complication. An orogastric tube was placed by the anesthesia team.The abdomen was prepped and draped in the usual sterile fashion. A timeout was performed, ensuring correct patient, correct procedure, correct site, and that all necessary personnel and equipment were in the room and available.
A vertical trans-umbilical incision was made safely through the skin and peritoneum to safely gain access into the abdominal cavity. A step needle, sheath and then 5 mm step port were placed and entry confirmed with the laparoscope. The abdomen was insufflated. The telescope was introduced and no signs of injury with entry were noted. The abdominal wall was palpated at the expected site of the gastrostomy tube, and then an incision made with 11 blade. The stomach was grasped with a small atraumatic grasper at the appropriate site proximal to the pylorus and opposite the incisura along the greater curvature. This part of stomach would easily reach the anterior abdominal wall and was elevated to the abdominal wall. An 0 PDS suture on a CT1 needle was used to anchor the stomach to the anterior abdominal wall on both sides of the proposed entry site into the stomach. The stomach was insufflated. The access needle followed by the Seldinger wire was passed into the stomach. A series of dilators were then used to dilate the abdominal wall and stomach up to a 20 French size. A 14 Fr x 2.0 cm Mini One gastrostomy tube was then passed thru the abdominal wall and into the stomach. The balloon was inflated with water under vision with 5 ml of water. A feeding attachment was secured to the tube. The PDS sutures to anchor the stomach were then tied over the tube on the exterior abdominal wall. The port site at the umbilicus was then closed with a single 2-0 vicryl suture and the skin was closed with 5-0 Monocryl. The umbilicus was dressed with sterile 2x2 gauze and Tegaderm. The gastrostomy dressed with 2x2 padding and Tegaderm..
All counts were noted to be correct. The patient was awakened and extubated without issue and transported to the PACU in stable condition with the gastrostomy tube to gravity drainage. The patient tolerated the procedure well.
Dr. Harmon was present and scrubbed throughout the duration of the procedure