Abstract
Background
Laparoscopic gastrostomy is the best alternative for long-term enteral feeding when percutaneous endoscopic gastrostomy is not possible. The aim of the present study was to determine the feasibility, complications, adequacy of feeding support, and tolerability of laparoscopic Witzel gastrostomy (LWG) in head and neck cancer patients. The initial results and the results of extended follow-up were evaluated.
Methods
A consecutive series of 48 patients with stenotic head and neck or esophageal cancer were referred for laparoscopic gastrostomy. The patients consisted of 42 men and 6 women aged 36 to 82 years (mean, 54 years). After laparoscopic placement of a Foley catheter of 16 F into the stomach, a seromuscular tunnel 4 cm in length is created, embedding the catheter by interrupted sutures. Three stay sutures for gastropexy are fixed and tied on the abdominal skin at the end of the procedure. The mean duration of the procedure was 62.4 ± 11 min (52–124 min).
Results
Laparoscopic Witzel gastrostomy could be performed successfully in all patients with aerodigestive cancer. None of the laparoscopic gastrostomy tube placement procedures was converted to an open surgery, and none of the 48 patients in this series died as a result of the laparoscopic procedure. All LWG complications (11%) were minor, consisting of superficial wound infections, balloon rupture, and chronic granulation. No major complications were encountered. The mean usage time of gastrostomy was 6.3 ± 5.3 months.
Conclusions
Current techniques of LWG could be an alternative to percutaneous endoscopic gastrostomy (PEG) for long-term enteral access, because it has proved to be safe and reproducible with relatively few complications.
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References
Au FC (1993) The Stamm gastrostomy: a sound procedure. Am Surg 59:674–675
Bailey CE, Lucas CE, Ledgerwood AM, Jacobs JR (1992) A comparison of gastrostomy techniques in patients with advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 118:124–126
Brink M8, Hagan K, Rosemurgy AS (1993) Laparoscopic insertion of the Moss feeding tube. J Laparoendosc Surg 3:531–534
Campos AC, Butters M, Meguid MM (1990) Home enteral nutrition via gastrostomy in advanced head and neck cancer patients. Head Neck 12:137–142
Cunliffe DR, Swanton C, White C, Watt-Smith SR, Cook TA, George BD (2000) Percutaneous endoscopic gastrostomy at the time of tumour resection in advanced oral cancer. Oral Oncol 36:471–473
Duh QY, Way LW (1993) Laparoscopic gastrostomy using t-fasteners as retractors and anchors. Surg Endosc 7:60–63
Edelman DS, Arroyo PJ, Unger SW (1994) Laparoscopic gastrostomy versus percutaneous endoscopic gastrostomy. A comparison. Surg Endosc 8:47–49
Gauderer M, Ponsky J, Izant R (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15:872–875
Jatoi A, Loprinzi C (2001) Current management of cancer associated anorexia and weight loss. Oncology 15:497–502
Johnston WD, Lopez MJ, Kraybill WG, Bricker EM (1982) Experience with a modified Witzel gastrostomy without gastropexy. Ann Surg 195:692–699
Larson DE, Burton DD, Schroeder KW, DiMagno EP (1987) Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 93:48–52
Lee WJ, Chao SH, Chang S, Chen KM (1994) Laparoscopic assisted gastrostomy tube placement. J Laparoendosc Surg 4:201–204
Mamel JJ (1989) Percutaneous endoscopic gastrstomy. Am J Gastroenterol 84:703–710
Mequid MM, Williams LF (1979) The use of gastrostomy to correct malnutrition. Surg Gynecol Obstet 149:27–32
Murayama KM, Johnson TJ, Thompson JS (1996) Laparoscopic gastrostomy and jejunostomy are safe and effective for obtaining enteral access. Am J Surg 172:591–594
Naud JP, Casa C, Manunta A (1995) Laparoscopic continent gastrostomy. Am J Surg 169:629–630
Nayel H, el-Ghoneimy E, el-Haddad S (1992) Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Nutrition 8:13–18
Peitgen K, Walz MK, Krause U, Eigler FW (1997) First results of laparoscopic gastrostomy. Surg Endosc 11: 658–662
Piquet MA, Ozsahin M, Larpin I, Zouhair A, Coti P, Monney M, Monnier P, Mirimanoff RO, Roulet M (2002) Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer 10:502–504
Reiner DS, Leitman IM, Ward RJ (1991) Laparoscopic Stamm gastrostomy with gastropexy. Surg Laparosc Endosc 1:189–192
Ritz JP, Germer CT, Buhr HJ (1998) Laparoscopic gastrostomy according to Janeway. Surg Endosc 12:894–897
Shellito PC, Malt RA (1985) Tube gastrostomy: techniques and complications. Ann Surg 201:180–185
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Hsieh, JS., Wu, CF., Chen, FM. et al. Laparoscopic Witzel gastrostomy—a reappraised technique. Surg Endosc 21, 793–797 (2007). https://doi.org/10.1007/s00464-006-9018-6
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DOI: https://doi.org/10.1007/s00464-006-9018-6