Gastrostomy

A gastrostomy (GT) is a tube inserted into the stomach via a surgical opening for the purpose of giving liquid feeds.

When they do the initial operation, they insert a gastroscope into the stomach, via the mouth, then turn off the theatre lights and switch on a light at the end of the gastroscope. This means that the stomach now glows and the surgeon can make an accurate incision into the stomach to create a little hole through which a tube is inserted. The first tube is a special one and is threaded through the stomach from within....like a button on the end of a thread....so that it can't come out. It is stitched into place (these are later removed) and also a tight flange is placed on the outside of the abdomen so that it will stay in place. The stomach wall is now sitting right next to the abdominal wall, because of the slight traction on the tube, and it knits together as it heals, creating a little tunnel or fistula.

After about 8 weeks, the first tube can be swapped, in theatre (as the tube has to be withdrawn from the inside, via the stomach/oesophagus), for a neat little snug Bard Button or a MicKey skin-level device, which looks like a floaties cap. These are fabulous and you would never know that they are there unless you had a peek. You can go swimming, and do whatever activitity you like. With a skin-level device, you simply attach a feeding tube with a small 50 ml barrel and run the feed in....or a longer special one that runs through a pump for a long drip feed.

Here is a Bard...the little mushroom part is inside the abdomen and the floaties cap is all you see. Andrew has his Bard replaced every year, under anaesthetic, which would be my recommendation for a child as there is some discomfort with the procedure. They use a special little stick called an Obturator, which stretches the entire BB to a thin shape and that is how they insert it. They then remove the obturator and it returns to shape.

Some of these GTs or PEGS (Per-Cutaneous Gastrostomies) are balloon-inflated, which means that people, like my girlfriend Kim in the states, can change their children's gts in the home when the balloon perishes and they fall out (usually around 3 - 6 months....but Andrew had a balloon-inflated MicKey that lasted a year). These wonderful skin-level devices have anti-leak valves in them too...so if the cap comes adrift, then nothing comes out.

Some people can tolerated bolus feeds....like Andrew....where it's all done in five minutes. Others, especially people with poor absorption (like children with fibrocystic disease) can be fed using a small pump like the Kanga. These can be carried unobtrusively in small back packs. I even met a lady who runs her pump in the car while she drives!

The feeds are specially formulated to contain every nutritious element anyone needs to survive on...and thrive on. Some are one calorie per ml, whilst more concentrated ones like Andrew's Resource Plus, are one and a half calories per ml. (There is also a 2 cals/ml formula.)

We are lucky in Victoria, through the wonderful efforts of Patsy Montgomery (of the Home Enteral Nutrition Service) to have subsidised formulas that public patients like Andrew, can get free-of-charge. Previously, we were paying almost $2000 per year...it's such a load off our minds now. Also we can have replacement feeding tubes (which plug into the Bards, etc) free every alternate month.

Doing a gastrostomy feed is a no-risk non-nursing procedure....anyone can do it. As Patsy said, the feed can't go any place it shouldn't. If it's not in the stomach, it's on the carpet! If my husband can do it, (he hates hospitals, etc) then anyone can.

We have the Australia-wide GISS (Gastrostomy Information Support Society) with branches in many capital cities. They run training sessions for support people at a small cost and also training sessions for organisations.

Victoria - Contact Hilary Johnson (National Co-ordinator) or Lyn Tatt (Victorian Co-ordinator), PO Box 608, Box Hill, VIC, 3128. Phone (03) 98432000 (business hours)