Stamm gastrostomy is a surgically placed feeding tube in the stomach.<\/p>\n
Usually performed through a small (6-8 cm) upper midline incision but can be performed through a upper left lateral horizontal incision also.<\/p>\n
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1. The incision is made in the skin with a No. 10 blade.<\/p>\n
2. Dissection for Stamm gastrostomy\u00c2\u00a0\u00c2\u00a0is done through the subcutaneous tissue with Bovie electrocautery.<\/p>\n
3. The midline (if vertical incision is used) is found and carefully incised with a knife or Bovie cautery.<\/p>\n
4. The preperitoneal fat is retracted upwards with forceps on either side of the midline and incised carefully using Bovie cautery.<\/p>\n
5. The peritoneum is grasped with forceps on either side of the midline and incised with a Metzenbaum scissors.<\/p>\n
6. The abdominal cavity is entered with care taken to take down any adhesions to the inner abominal wall with gentle traction and using the Metzenbaum scissors.<\/p>\n
7. Babcock clamps are used to grasp the anterior stomach wall in the mid to slightly distal stomach and to elevate it into the wound.<\/p>\n
8. A circular purse-string suture is placed with a diameter of 1.5 – 2.0 cm using a 2-0 or 3-0 silk suture with the ends left untied.<\/p>\n
9. A concentric purse-string of 2-0 or 3-0 silk is then placed just outside of the first purse-string with the ends left untied.<\/p>\n
10. A small opening is made in the serosa of the stomach in the center of the two concentric pursestring sutures, usually by placing the Bovie cautery onto the surface for a second.<\/p>\n
11. A hemostat is used to grasp the inner mucosal layer of the stomach and to pull it up through the opening made in the serosa.<\/p>\n
12. This lip of mucosa is then amputated using the Bovie cautery.<\/p>\n
13. The hole in the anterior stomach is widened slightly by placing the tips of a closed hemostat into the hold and then spreading.<\/p>\n
14. A 18-22 French Foley balloon catheter is then placed into the stomach through the just made opening.<\/p>\n
15. The balloon is inflated and then pulled up tight against the inner surface of the stomach.<\/p>\n
16. First the inner and then the outer sutures are cinched down and tied.<\/p>\n
17. The stomach with the protruding Foley catheter is them moved up against the inside of the abdominal wall to see where the exit site of the Foley should be positioned.<\/p>\n
18. A stab wound is made in the skin with a No. 11 blade.<\/p>\n
19. Bovie cautery is used to control and skin bleeding, which is usually slight in Stamm gastrostomy.<\/p>\n
20. A Schnitt forceps is bluntly forced through the stab wound into the abdominal cavity and the tips are opened.<\/p>\n