Читать книгу Gastrointestinal Surgical Techniques in Small Animals - Группа авторов - Страница 72

Endoscopic placement of gastrostomy is recommended for patients not undergoing laparotomy. Endoscopic placement is contraindicated for patients with esophageal stricture.

The patient is placed in right lateral recumbency. A flexible endoscope is advanced in the stomach. After sufficient insufflation of the stomach an 18 gauge over‐the‐needle catheter is placed percutaneously in the lumen of the stomach. A suture is then threaded in the catheter. A snare or a grasping forceps can grab the suture in the lumen of the stomach. The suture is then pulled out through the esophagus and the mouth of the patient. The suture has to be long enough to exit in the oral cavity and still be present through the abdominal wall. Another over‐needle catheter is threaded over the suture and the gastrostomy tube securely attached to the suture. The proximal end of the gastrostomy tube is wedged in the flared end of the over‐needle catheter. A mushroom‐tipped catheter is used. The suture is then pulled from the abdominal wall to bring the gastrostomy tube in the lumen of the stomach. A small skin incision is made to facilitate the passage of the catheter through the abdominal wall. A Chinese finger‐trap suture with 2‐0 nylon is then used to secure the gastrostomy tube to the skin (Song et al. 2008). The endoscope can be reintroduced to confirm appropriate placement of the gastrostomy tube.