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 opening is formed on the anterior abdominal - stoma. Through it, food directly enters the stomach cavity. One of the varieties of this surgical intervention is the Witzel gastrostomy. The operation was proposed in 1891 and is currently being used. 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 givesthe ability to take food enterally. This intervention is performed in cases where radical surgical treatment is not indicated. In oncological practice, a permanent gastrostomy is most often applied. The indications for such palliative surgical treatment are as follows:
- Malignant neoplasms of the esophagus and pharynx.
- Gastroesophageal cancer.
- Tumor of the cardia of the stomach.
- Severe burn of the esophagus with stricture formation.
- Violation of the swallowing reflex due to damage to the nervous system.
- Neoplasms of the mediastinum, squeezing the upper parts of the digestive system.
Permanent Witzel gastrostomy is reserved for severe cases where no other treatment is possible. It negatively affects the quality of life of the patient, but is the only way out for these pathologies. In some cases, gastrostomy is a temporary phenomenon. The operation is done in order to provide enteral nutrition until the patient can eat naturally. Indications for temporary gastrostomy are:
- Injuries to the pharynx and esophagus from wounds.
- Jaw injuries.
- Fistula formation between the esophagus and the trachea or bronchi.
- Burn of the mucous membranes of the upper gastrointestinal tract, requiring rehabilitation measures.
- Severe emaciation in preparation for major surgical interventions on the organs of the digestive system.
The surgeon independently decides on the technique and indications for surgerygastrostomy. If it is possible to avoid the imposition of 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 carrying out surgical treatment, it is required to prepare a weakened patient. For this purpose, infusion therapy and correction of water and electrolyte balance are necessary. With severe anemia, a blood transfusion is performed. If possible, gastric lavage is performed before surgery. In the absence of severe hemodynamic disturbances, general anesthesia is administered.
Witzel Gastrostomy: Technique
During the development of palliative surgery, many gastrostomy techniques have been developed. The indications for them are similar, they differ from each other in the way the fistula is formed. The Witzel gastrostomy has advantages over previously developed techniques. The peculiarity of the operation is that the digestive tube is formed from the anterior wall of the stomach. This helps to ensure that the channel becomes airtight, that is, the contents do not spill out of the organ cavity.
The operation starts with a vertical laparotomy. The incision is made along the left rectus abdominis muscle. The anterior 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. The anterior wall of the stomach is sutured around the tube. Thena hole is made in the organ, into which the stoma is immersed. The resulting canal is sutured to the wall of the stomach in such a way 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 surgery
One of the most successful modifications of palliative care is the Witzel gastrostomy. The technique of operation allows to reduce complications to a minimum. In most cases, doctors manage to achieve complete tightness of the stoma. However, if the contents of the stomach enter the hole between the rubber tube and the tissues, the formed channel becomes suppurated. This threatens the development of peritonitis.
Gastrostomy recovery period
In the first days after the application of the gastrostomy, it is allowed to enter only liquid food 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, pureed soups, mashed vegetables, yogurts. Patients require constant care and psychological support from relatives.
