A simplified and safe method of open gastrostomy

The establishment of a gastrostomy by the percutaneous endoscopic route (PEG) is now accepted as a safe and easy procedure which can be performed under combined sedation and infiltration of local anaesthetic at the chosen site on the anterior abdominal wall. However, surgeons are still not infrequently called upon to perform an open gastrostomy in a selected group of patients, namely: (1) those with extensive laryngeal and pharyngeal tumours in whom it is impossible to pass even a paediatric gastroscope; (2) neonates with oesophageal atresia. Various forms of open gastrostomy have been described through the years. The Foley and dePezzer catheters are commonly used for such gastrostomies. These latex catheters are prone to problems such as tube migration (causing intestinal obstruction), fractures and balloon rupture. The mushroom catheter used in the PEG procedure is easier to manage and lasts longer without requiring replacement. It has a retaining disc at its skin exit site, preventing migration, and can also be closed to prevent leakage of gastric contents. We report a quick and easy way of performing an open gastrostomy utilizing the advantages of the mushroom catheter where the wound and the gastrostomy site are also separate.