A Method for Performing a Gastrostomy Using a Polypropylene Mesh

International Journal of Biomedicine 9(4) (2019) 370-372 http://dx.doi.org/10.21103/Article9(4)_ShC1 SHORT INTERNATIONAL JOURNAL OF BIOMEDICINE COMMUNICATION A Method for Performing a Gastrostomy Using a Polypropylene Mesh Sergey N. Shurygin, PhD, ScD¹; Alexander V. Kutenev, PhD²; Leonid V. Safonov, PhD¹*; Inna V. Pastukhova, PhD³; Irina N. Shurygina²; Alexey G. Vaganov4; Archil S. Tsulaya5 ¹Federal Scientific Center for Physical Culture & Sports, Moscow, Russia ²RUDN University, Moscow, Russia ³First Moscow State Medical University (Sechenov University), Moscow, Russia 4 State Budgetary Institution of Healthcare of the City of Moscow «City Clinical Hospital No.29», Moscow, Russia 5 Budgetary Institution of Health «Clinical Hospital V.M. Buyanova», Moscow, Russia Abstract Gastrostomy is one of the main palliative surgical methods for restoring enteral nutrition. The aim of the study was to develop a new method of gastrostomy that reduces the frequency of complications. The prototype for the described method is Depage-Janeway gastrostomy with use of the GIA stapler. The proposed method is characterized by the use of polypropylene mesh. This provides a tight attachment of the wall of the stomach to the anterior abdominal wall, which reduces the risk of complications. (International Journal of Biomedicine. 2019;9(4):370-372.) Key Words: gastrostomy • palliative surgical methods • polypropylene mesh Method Description Gastrostomy is one of the most common palliative operations, the main indication for which is the need to restore enteral nutrition (1) in patients with severe neurological diseases associated with impaired swallowing, as well as in patients with a tumor obstruction of the upper digestive tract. However, indications for gastrostomy are constantly expanding and, in addition to solving palliative tasks, it is often used in a complex of rehabilitation (2) and therapeutic measures.(3) To date, about 100 different modifications of gastrostomy have been published in the literature. According to the method of application, they can be divided into 3 categories: open “traditional” methods (Witzel, Stamm – Kader, Toprover gastrostomy), laparoscopic gastrostomy, and percutaneous gastrostomy under endoscopic or radiological control. The traditional open methods for applying gastrostomy include Witzel gastrostomy,(4) which is still one of the most common operations performed in general surgical hospitals.(5) Accordingly, with the expansion of indications for gastrostomy, this operation is still relevant to the improvement *Corresponding author: Leonid V. Safonov, PhD. Federal Scientific Center for Physical Culture & Sports; Moscow, Russia. E-mail: of existing gastrostomy techniques and the development of new ones;(6) it reduces the risk of gastrostomy insolvency, gastrostomy tube migration, and wound complications due to leakage of the structure, and it eliminates the need for the use of additional devices that fix the gastrostomy tube. The purpose of the work was the development of a new method of gastrostomy to improve the treatment results in patients who have indications for applying gastrostomy. Closest to the proposed method is Depage-Janeway gastrostomy using the GIA stapler.(7) This method was taken as a prototype method. The method of gastrostomy using a polypropylene mesh (Patent RU No. 2691924; priority of 06.18.2019; Bulletin No. 17) is implemented as follows. An upper median laparotomy is performed. The anterior wall of the stomach (Fig.1) is pulled up with two Babcock clamps to form a gastric tube 8-10 cm long. In addition, the diameter of the tube is calculated so that it allows insertion and removal of a Foley (18-22 F) catheter for feeding the patient. A GIA type stapler is placed perpendicular to the greater curvature of the stomach. The apparatus suture should end 2.5 cm from the greater curvature of the stomach. The device leaves 4 rows of sutures, 2 on each side, in the form of a double variable line of brackets. At the same time, the knife of the GIA apparatus cuts the stomach between both double rows of sutures, forming a closed gastric tube in the form of a diverticulum with a S. N. Shurygin et al. / International Journal of Biomedicine 9(4) (2019) 370-372 base at the greater curvature of the stomach. The apparatus suture is placed as the knotted cotton or silk seams. From a polypropylene mesh, 2 polypropylene mesh implants are modeled (Fig.1). The first of them is cut out in the form of an oval plate with a diameter of 6-7 cm, with a central hole (7 mm in diameter) through which the gastric tube is drawn. The second implant is cut out in a rectangular shape along the length of the gastric tube. The stomach tube is passed through the first implant, which is fixed to the gastric wall along the perimeter by separate sutures with 3/0 polypropylene thread. The second implant, in the form of a clutch, wraps the gastric tube and is fixed on the gastric tube with individual polypropylene sutures. Two implants are sutured together by separate sutures with 2/0 polypropylene thread. To the left of the midline incision, a hole of 1.5-2 cm is made in the projection of the left rectus abdominis muscle, where a Foley catheter (18-22F) is inserted into the abdominal cavity. The gastric tube is crossed along the diameter of the catheter, the catheter is inserted into the lumen of the stomach, and the catheter balloon is inflated through a special cannula. The gastric tube is fixed with separate sutures of polypropylene 2/0 thread to the parietal peritoneum and the muscular aponeurotic layer. 371 postoperative period with daily wound treatment, changing dressings after 3 weeks, the stomach-fixing sutures are gradually removed as the implants germinate with connective tissue, which provides an increasingly tight attachment of the stomach wall to the anterior abdominal wall. Fig. 2. The final stages of the gastrostomy using a polypropylene mesh. In three places in the projection of the first implant, the anterior abdominal wall is stitched, as well as the wall of the stomach, with a mesh fixed by a serous-muscular suture with polypropylene thread. The wall of the stomach is firmly pressed to the anterior abdominal wall. On the skin, 3 knots are tied. Fig. 1. The first stages of gastrostomy using a polypropylene mesh. General view of the stomach with a formed gastric stalk with two mesh implants. 1. The anterior wall of the stomach; 2. Gastric tube; 3. The first polypropylene mesh implant (oval shape); 4. The second polypropylene mesh implant (rectangular shape); 5. A surgical hole of 1.5-2 cm in the greater curvature of the stomach; 6. Aperture in the anterior abdominal wall through which the gastric tube is drawn; 7. Foley catheter; 8. Cannula for inflating a Foley catheter In three places in the projection of the first implant, the anterior abdominal wall is stitched (Fig.2), as well as the wall of the stomach, with a mesh fixed by a serous-muscula (...truncated)