The stomach is one of the main organs of the digestive tract. It performs an evacuation function. It also carries out the initial digestion of food, all thanks to hydrochloric acid. In cases of severe gastrointestinal disease, doctors have to resort to gastrostomy. This operation is necessary if food cannot enter the stomach. For example, with obstruction of the esophagus by a tumor or gastroesophageal cancer.
In such cases, an artificial hole is formed on the anterior abdominal - the stoma. Through it, food directly enters the cavity of the stomach. One of the varieties of this surgical intervention is a Witzel gastrostomy. The operation was proposed in 1891 and is currently in use. Thanks to the gastrostomy developed by Witzel, it was possible to achieve adequate sealing of the artificial opening. Most often, such an operation is used in oncology.
Indications for gastrostomy
Gastrostomy is a type of palliative surgery. It does not eliminate the underlying disease, but makes it possible to eat in an enteral manner. This intervention is performed in cases where radical surgical treatment is not indicated. In oncological practice, a constant gastrostomy is most often superimposed. Indications for such palliative surgical treatment are as follows:
- Malignant neoplasms of the esophagus and pharynx.
- Gastroesophageal cancer.
- Tumor of the cardiac section of the stomach.
- Severe burn of the esophagus with the formation of stricture.
- Violation of the swallowing reflex due to damage to the nervous system.
- Neoplasms of the mediastinum, compressing the upper digestive system.
Permanent Witzel gastrostomy is prescribed in severe cases when other treatment is not possible. It negatively affects the quality of life of the patient, but is the only way out with these pathologies. In some cases, a gastrostomy is a temporary phenomenon. The operation is done in order to provide enteral nutrition, while the patient can not eat food in a natural way. Indications for temporary gastrostomy are:
- Damage to the pharynx and esophagus during wounds.
- Jaw injuries.
- The formation of fistulas between the esophagus and the trachea or bronchi.
- A burn of the mucous membranes of the upper gastrointestinal tract, requiring rehabilitation measures.
- Marked exhaustion in preparation for serious surgical interventions on the digestive system.
The surgeon independently decides on the technique and indications for gastrostomy surgery. If it is possible to avoid imposing an unnatural digestive tube, this surgical treatment will not be performed.
Witzel Gastrostomy: preparation
In most cases, palliative surgery is performed with advanced forms of oncological pathologies. Therefore, before conducting surgical treatment, it is required to prepare a weakened patient. For this purpose, infusion therapy and correction of the water-electrolyte balance are necessary. With severe anemia, a blood transfusion is performed. If possible, gastric lavage is performed before surgery. In the absence of pronounced hemodynamic disturbances, general anesthesia is administered.
Witzel Gastrostomy: Technique
During the development of palliative surgery, many gastrostomy techniques have been developed. Indications for them are similar, they differ among themselves in the way the fistula is formed. Witzel Gastrostomy has advantages over previously developed techniques. The peculiarity of the operation is that the digestive tube is formed from the front wall of the stomach. This helps to ensure that the channel becomes airtight, that is, the contents do not spill out from the organ cavity.
The operation begins with a vertical laparotomy. The incision is performed along the left rectus abdominis muscle. The front surface of the stomach is brought out and a rubber tube is placed in the area of the cardia. Its diameter is 0.8 cm. Around the tube, the front wall of the stomach is hemmed. Then a hole is made in the organ into which the stoma is immersed. The resulting channel is sutured to the wall of the stomach so as to minimize the resulting fold. Then the organ is attached to the peritoneum. The wound around the stoma is sutured in layers.
Possible complications of the operation
One of the most successful modifications of palliative treatment is Witzel gastrostomy. The technique of the operation allows minimizing complications. In most cases, doctors manage to achieve complete tightness of the stoma. However, when stomach contents get into the hole between the rubber tube and tissues, suppuration of the formed channel occurs. This threatens the development of peritonitis.
Recovery period after gastrostomy
In the first days after the application of the gastrostomy, only liquid food is allowed to be administered in small portions. Gradually, the frequency of meals is reduced, and the volume increases. After complete healing, a funnel is attached to the stoma opening. It is allowed to introduce various broths, tea, compote, mashed soups, mashed vegetables, yoghurts. Patients require ongoing care and psychological support from relatives.