Patient education: Surgical gastrostomy (The Basics)

What is gastrostomy? — Gastrostomy is surgery to put in a feeding tube. Feeding tubes are a way of getting the nutrients you need if you cannot get enough nutrition from eating or drinking by mouth.

During the procedure, the doctor will make a cut (incision) in the stomach wall. Then, they will insert a feeding tube that goes into the stomach. The type of feeding tube put in through gastrotomy is called a "gastrostomy tube," or "G tube" (figure 1).

G tubes are usually needed for people who will be unable to get enough nutrition from eating or drinking by mouth for 4 weeks or longer. Before surgery, your doctor will talk to you about how long you will need the G tube.

This surgery can be done in 2 ways:

●Open surgery – During open surgery, the doctor makes a cut, or "incision," in the belly to insert the G tube. This lets them see directly inside the belly when they do the surgery.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller incisions in the belly. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to know where to cut and where to place the G tube. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for gastrostomy? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might want you to get tests, such as:

●X-ray

●Lab tests

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time.

●Lowering the risk of infection – You might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during gastrostomy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get "general anesthesia" medicines – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. With general anesthesia, you usually get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision in your stomach wall to put in the feeding tube. One end of the tube will stay outside of your body. The other end will be guided into your stomach (figure 1).

●The G tube will have something on the inside, like a small balloon or bumper, to hold it in place. This will also prevent the tube from coming out.

●The doctor will cover the area with clean bandages.

What happens after gastrostomy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You will see tape holding the tube in place on your belly. You will also have a bandage over the incision where the tube was put in.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

Within 24 hours after your surgery, a doctor or nurse will "flush" the G tube with water. You will probably get your first feeding through the tube the day after your surgery. But in some cases, it might be sooner or later.

What are the risks of gastrostomy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding

What else should I know? — Before you go home from the hospital, make sure that you know how to keep your tube and incision clean. You also need to know how, when, and what to feed yourself through the tube. Ask what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions.

●If you will need a G tube for longer than 4 weeks, the tube might need to be replaced. Depending on the type of tube you have, you might be able to replace it yourself at home. Otherwise, your doctor will need to replace it for you.

●You might eventually get a type of feeding tube called a "G button." With a G button, there is no extra tubing sticking out of the stomach wall. Instead, you have a "button" that is mostly flat against your skin.

More on this topic

Patient education: Surgical gastrostomy – Discharge instructions (The Basics)
Patient education: Enteral (tube) feeding (The Basics)
Patient education: How to give a tube feeding (The Basics)
Patient education: How to care for a G tube or G button (The Basics)
Patient education: How to care for a nasogastric tube (The Basics)
Patient education: Percutaneous endoscopic gastrostomy (PEG) in adults (The Basics)