Profile of 151 Patients Undergoing Open Gastrostomy an a Cancer Hospital

C l i n M e d International Library Citation: Meyer MMMMDE, Santos EC, de Souza TE, Neto PV, França LM, et al. (2016) Profile of 151 Patients Undergoing Open Gastrostomy an a Cancer Hospital. J Clin Gastroenterol Treat 2:030 Received: May 24, 2016: Accepted: July 06, 2016: Published: July 08, 2016 Copyright: © 2016 Meyer MMMMDE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Meyer et al. J Clin Gastroenterol Treat 2016, 2:030


Introduction
The gastrostomy is one of the oldest surgical procedures performed since the early nineteenth century.Its main objective is to provide a nutritional pathway for patients who are unable to maintain adequate long term oral intake.Many surgical techniques have been described and used, consequently, the open surgery is progressively losing space for minimally invasive techniques [1].
The literature currently describes three techniques: percutaneous fluoroscopic gastrostomy (PFG), percutaneous endoscopic gastrostomy (PEG) and surgical gastrostomy, which may be performed via laparotomy or laparoscopy [2].
Although PEG is already known to be safer [3], the surgical gastrostomy is an option in the following situations: the patient will classification of surgical risk, using the ASA score, 0.7% was classified as ASA I, 84.8% as ASA II and 14.5% as ASA III.Of all patients, 28.5% had no comorbidities, and, among the most prevalent comorbidities, 10.6% suffered from hypertension, 4.6% were smokers (current smokers) and 2.6% had chronic obstructive pulmonary disease.The preoperative diagnosis was esophageal tumor in 63.7% of patients, head and neck tumors in 32.3% and others in 4% (Figure 1).
The average length of stay in the hospital for the procedure was five days.There were complications in the immediate postoperative period in 29.1% of cases, and, among the most prevalent complications, it was found vomiting (4%), bleeding (2%), tube displacement (2%), peri-tube leakage (1.3%), need of tube replacement (1.3%), intolerance to enteral diet (0.7%) and other not listed complications in 18.5% of patients.In 53.6% of cases, patients had to return to the emergency room after surgery, and the average was one visit and 37 days after hospital discharge.
The most common reasons that led patients to the emergency room were the the tube displacement and need of replacement (30.12%), peri-tube leakage (22.89%), vomiting (4.82%), intolerance to enteral diet (1.2%), bleeding (1.2%) and other (9.64%).Rehospitalization was required in 16.6% of patients and one patient died after gastrostomy (Figure 2).

Discussion
Among the limiting factors for the use of minimally invasive techniques to perform a gastrostomy, is the availability of required human and material resources.At our institution we are not able to perform PEG nor PFG and this is often the reality in brazilian public health system.The high cost associated with endoscopic or laparoscopic techniques can be seen as an obstacle, although the open surgery is associated with a higher percentage of complications and this can lead to extra post-operative expenses related to hospital length of stay, visits to emergency room and readmissions [6,7].
The data regarding the preoperative diagnosis of patients should also be taken into consideration when analyzing the results.It is observed that 63.6% of patients suffered from esophageal tumor.This underlying condition often precludes the execution of PEG, since this technique depends on the passage of the endoscope through the esophagus to access the stomach [8].Other important factors to consider are the high rates of return to emergency care (53.6%) and hospital readmissions (16.6%) after surgery.Although the open gastrostomy is related to more frequent postoperative complications, the complications that most motivated the visit to the emergency room were displacement of the tube, in 30.12% of cases, and peri-tube leakage, in 22.89% of cases.These complications probably could be minimized with the use of more adequate material -the tube available and used during the period of study was a 22 French Foley catheter.The prolonged average hospitalization time for the procedure (5 days) can be explained by the fact that often the patients undergoing gastrostomy in our service are evaluated for the first time in outpatient clinics in poor conditions, with long-term dysphagia, meaningful weight loss and dehydration.Thus, they are admitted to the hospital for intravenous hydration, preoperative preparation and scheduling the surgery [9][10][11].

Conclusion
Despite the gradual replacement of open surgical techniques for the minimally invasive ones, many gastrostomies still being done by open surgery.The assessment of alternatives should consider the costs and associated morbidity, not ignoring the limitations of each method and each service, and trying to optimize the techniques according to the resources available.