Use of a Laparoscopic Witzel Gastrostomy Without Gastropexy in Bariatric and General Surgery
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Use of a Laparoscopic Witzel Gastrostomy Without Gastropexy in Bariatric and General Surgery Joshua Davies 1 Cullen Carter 1
&
Luise Pernar 1 & Danielle Eble 2 & Adolfo Z. Fernandez 3 & Brian Carmine 1 & Donald Hess 1 &
Received: 21 April 2020 / Revised: 20 July 2020 / Accepted: 22 July 2020 # The Author(s) 2020
Abstract Background Gastrostomy placement is the preferred means of long-term enteral feeding for patients who cannot eat by mouth. During laparoscopic gastrostomy, it is standard to perform gastropexy, apposing visceral and parietal peritoneum. In some settings, due to altered anatomy from prior surgery, direct apposition of the stomach to the abdominal wall is not possible. This study reports a series of cases where laparoscopic gastrostomy was performed via a Witzel approach without gastropexy. Methods A retrospective chart review was performed of all patients at a tertiary academic medical center who underwent Witzel gastrostomy without gastropexy over a 3-year period. In each case, an 18-French tube was placed into the fundus of the stomach and secured with a purse-string suture. A 5-cm serosalized Witzel tunnel was created around the tube using running silk suture. No gastropexy was performed. Results Six patients underwent 7 Witzel gastrostomy procedures. In three cases, patients had undergone prior major upper abdominal surgery where adhesive disease prevented gastropexy. In the other four cases, the patients had undergone prior gastric bypass with antecolic antegastric position of the roux limb. No patient suffered leak of gastric contents into the peritoneum, and there were no postoperative complications or mortality related to the gastrostomy. Conclusion In cases where enteral access is necessary, and where the stomach cannot reach the anterior abdominal wall for gastropexy due to prior surgeries, a Witzel gastrostomy without gastropexy is a safe option which resulted in no morbidity or mortality in our series. Keywords Laparoscopy . Gastrostomy . Gastric bypass . Enteral access
Introduction Enteral nutritional access is the preferred means of delivering nutrition to patients who require prolonged supplementation. For most patients, percutaneous endoscopic gastrostomy
* Joshua Davies [email protected] 1
Department of Surgery, Boston Medical Center, 1 Boston Medical Center Place, Collamore Suite D501, Boston, MA 02118, USA
2
Department of Surgery, University of Washington, 329 Ninth Ave, Box 359796, Room 7EH-70, Seattle, WA 98104-9796, USA
3
Department of Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, 5th Floor, Winston-Salem, NC 27157, USA
(PEG) can be safely performed with low complication rates and has thus replaced open gastrostomy as the procedure of choice in establishing gastric access [1, 2]. Image-guided percutaneous gastrostomy is also a safe means of gastric access and has outcomes similar to those of PEG [3]. While prior abdominal surgery was initially considered a contraindication to PEG, several authors have reported PEG
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