Campoli Paulo M O, Cardoso Daniela M M, Turchi Marília D, Ejima Flávio H, Mota Orlando M
Department of Digestive Endoscopy, Araújo Jorge Hospital, Goiás Anticancer Association, Goiânia, GO, Brazil.
BMC Gastroenterol. 2009 Jun 26;9:48. doi: 10.1186/1471-230X-9-48.
Percutaneous Endoscopic Gastrostomy (PEG) performed through the Introducer Technique is associated with lower risk of surgical infection when compared to the Pull Technique. Its use is less widespread as the fixation of the stomach to the abdominal wall is a stage of the procedure that is difficult to be performed. We present a new technical variant of gastropexy which is fast and easy to be performed. The aim of this study was to evaluate the safety and feasibility of a new technical variant of gastropexy in patients submitted to gastrostomy performed through the Introducer Technique.
All the patients submitted to PEG through the Introducer Technique were evaluated using a new technical variant of gastropexy, which consists of two parallel stitches of trasfixation sutures involving the abdominal wall and the gastric wall, performed with a long curved needle. Prophylactic antibiotics were not used. Demographic aspects, initial diagnosis, indication, sedation doses, morbidity and surgical mortality were all analyzed.
Four hundred and thirty-five consecutive PEGs performed between June 2004 and May 2007 were studied. Nearly all the cases consisted of patients presenting malignant neoplasia, 79.5% of which sited in the head and neck. The main indication of PEG was dysphagia, found in 346 patients (79.5%). There were 12 complications (2.8%) in 11 patients, from which only one patient had peristomal infection (0.2%). There was one death related to the procedure.
Gastropexy with the technical variant described here is easy to be performed and was feasible and safe in the present study. PEG performed by the Introducer Technique with this type of gastropexy was associated with low rates of wound infection even without the use of prophylactic antibiotics.
与牵拉技术相比，经导入器技术进行的经皮内镜下胃造口术（PEG）手术感染风险较低。由于胃与腹壁的固定是该手术中一个难以实施的步骤，其应用并不广泛。我们提出了一种新的胃固定技术变体，操作快速且简便。本研究的目的是评估在接受经导入器技术进行胃造口术的患者中，一种新的胃固定技术变体的安全性和可行性。
所有经导入器技术接受PEG的患者均采用一种新的胃固定技术变体进行评估，该技术包括用长弯针进行的涉及腹壁和胃壁的两针平行贯穿缝合。未使用预防性抗生素。对人口统计学特征、初始诊断、适应证、镇静剂量、发病率和手术死亡率进行了分析。
对2004年6月至2007年5月期间连续进行的435例PEG进行了研究。几乎所有病例均为患有恶性肿瘤的患者，其中79.5%位于头颈部。PEG的主要适应证是吞咽困难，在346例患者（79.5%）中发现。11例患者出现12例并发症（2.8%），其中仅1例患者发生造口周围感染（0.2%）。有1例与手术相关的死亡。
本文所述技术变体的胃固定术易于实施，在本研究中是可行且安全的。采用这种胃固定术的经导入器技术进行的PEG即使不使用预防性抗生素，伤口感染率也较低。
