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Gastrostomy - Medical Negligence

A gastrostomy procedure is one done on the abdominal wall. During the procedure a hole is made into the abdominal wall and stomach for the placement of a gastrostomy tube or “g-tube”, which is used for drainage of the stomach contents or for feeding. There are two reasons for a gastrostomy to be formed. The first is because a patient is not getting in enough calories and must be fed through a gastrostomy tube. This can happen because of a birth defect involving the neuromuscular condition, the stomach, the esophagus or the mouth. There can also be an acquired weakness of the muscles involved in chewing and swallowing. The gastrostomy can also be done to drain the stomach whenever there is a long lasting blockage of the outlet of the stomach into the small intestines. This can mean there is a severe peptic ulcer causing the blockage or a tumour distal to the stomach.

There is a certain procedure in doing the gastrostomy tube. The surgery is performed under general anaesthesia so the patient isn’t aware of having it done. If the patient cannot tolerate general anaesthesia, local anaesthesia can be performed. A hole is cut into the skin and through the wall of the stomach. The stomach is sewn onto the abdominal wall to make one layer. The gastrostomy tube is placed through the hole, called the stoma. A disc or a water filled balloon is used to keep the disc from falling out of the body. The balloon has a valve to keep the water inside it.

The hole is made by inserting a lighted endoscope through the mouth. When it reaches the stomach the room is dimmed so that the light can be seen from the outside. The incision is made over the source of the light for the best accuracy. The entire procedure takes about a half an hour.

The patient may need to stay in the hospital for just a day but may need a lengthy stay if other health problems or malnutrition need to be treated. The connected stomach and abdominal wall generally fuse together and heal after about 5 to 7 days. The surgical costs depend on how healthy the patient is and how old they are. In general, the younger person is generally more ill and will require intensive care and care that is more expensive.

To make sure that things are properly done without adverse effects, blood and urine testing is done along with an endoscopy and gastrointestinal x-rays. They are evaluated for their ability to tolerate general anaesthesia unless local anaesthesia is formed.

After the procedure, the patient still needs IV antibiotics for a minimum of one day. When bowel sounds are present, the gastrostomy tube can allow clear liquids. Tube feedings can get thicker over time. Patients are taught how to prevent a local infection and how to manage the feedings. This can all be done at home as long as a supply of liquid nutrition is available. Tube blockage can happen and patients need to know what to do when that happens.

Risk & Complications

In general, a gastrostomy tube placement surgery is not particularly risky but those that are already sick have a greater chance of complication. The major risk is infection. Infection can occur in the first few days postoperatively or months after the gastrostomy has been placed. Patients can also experience nausea and diarrhoea due to an inability to tolerate the feeding substance.

Bleeding can occur from the surgery itself and the tube can become dislodged. The stomach can become unnaturally bloated due to problems with the catheter. While the procedure is generally safe, certain patients are at higher risk than average. These include the obese, those that smoke, those who use alcohol or any illicit drugs and those who take prescription medications that badly interfere with the receiving of anaesthesia.