Gastrostomy and Jejunostomy

The establishment and care of long-term enteral access presently occupies a signifi cant segment of pediatric surgical practice. Although pediatric surgeons have become more selective in the use of gastrostomies and jejunostomies for congenital malformations, during the last decades there has been a marked increase in the placement of feeding stomas in infants and children without associated surgical conditions. This has come about mainly because of the ever increasing survival of patients with inability to swallow secondary to central nervous system disorders and children who require feeding supplementation, special diets, and frequent administration of multiple medications. Refi nements in the traditional access procedures and the addition of newer and simpler endoscopically, radiologically, ultra-sonographically, and laparoscopically aided techniques have enhanced the safety and expanded the applicability of these upper intestinal stomas. Additionally, the use of softer, minimally irritating materials in the manufacture of traditional catheters and, more importantly, the development of skin-level devices have greatly reduced complications and facilitated the long-term use of these enteral routes.

Although these developments are clearly benefi cial, the indication of a long-term feeding stoma can be quite diffi cult, often involving serious ethical considerations. The most desirable outcome is usually achieved by a team approach including parents, primary physicians, gastroenterologists, nutritionists, nurses, and other professionals who will be involved with the management of the child.