Laparoscopic gastrostomy using T-fasteners as retractors and anchors.
Most feeding or venting gastrostomies can be placed percutaneously via gastroscopy. Laparotomy is required if gastroscopy is not possible--for example, in patients with esophageal strictures or large tumors. We have developed a new technique of laparoscopic gastrostomy, and used it successfully in three patients. The key to this technique is the T-fastener, a nylon suture attached to a metal T-bar, which is introduced via a slotted needle percutaneously and dislodged inside the stomach lumen. Four T-fasteners secure the stomach wall to the anterior abdomen. A balloon catheter gastrostomy tube is then placed over a J-wire through the center of these T-fasteners. This technique requires no gastroscopy or intracorporeal suturing and needs only one port for the laparoscope. It is safe and simple and can be used for patients who require a gastrostomy in whom gastroscopy is not possible or is risky.
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Surgical Service, Veterans Affairs Medical Center, San Francisco, CA 94121.
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D000328:Adult; D000368:Aged; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D013536:Suture Techniques