ABSTRACT
When the decision to provide long-term nutritional support to the patient has finally been made the surgeon has several options regarding specific technique. The debate o f enteral vs. parenteral has been discussed elsewhere. Now that the decision has been made to provide enteral feedings, the choice of what type of enteral access comes to the forefront. Essentially two sites exist for enteral access; the stomach and the small bowel, more specifically the jejunum. Gastric devices are generally pre ferred because they offer the most flexibility in feeding schedules. Patients may be fed using either a continuous drip or with bolus feedings, which allow a more regu lar lifestyle. However, gastric feeding is only appropriate in those patients who have intact gag and cough reflexes, and adequate gastric emptying. The combination of poor gastric emptying, reflux with possible aspiration, and the inability to protect the airway can be deadly! Small bowel devices are indicated for those patients who may be at risk for aspiration due to any compromise in glottic closure, cough reflex, or gastric emptying. The choice o f location o f enteral feeding sites will also be af fected by the type o f surgery and/or pathology that the patient has. For instance, si p esophageal resection for adenocarcinoma, the patient would probably be better served by a jejunostomy than a gastrostomy access procedure. Once the decision has been made regarding where to place the enteral access, gastric vs. jejunal), the next decision is how to access the GI tract. In these next few sections we will assess the different surgical access procedures. (Fluoroscopically placed devices and procedures will not be discussed here.)
G a stro sto m y Gastrostomies may be placed using essentially three main techniques that are
within the scope of the general surgeon; 1. Open technique, 2. Endoscopic technique, and 3. Laparoscopic technique.
