Peritonitis, resulting from either malpositioning of the gastrostomy tube or leakage
to the peritoneal cavity [1]
[2]
[3] is reported as a major complication following the percutaneous endoscopic gastrostomy
(PEG) procedure, which may lead to lethal conditions including sepsis.
The aim of this study was to evaluate safety with regard to a novel step: a three-point
triangular fixation of the stomach to the abdominal wall in the PEG procedure (Fig.
[1]). We applied this three-point fixation, using a commercially available fixation
kit, the ”Funada-style” kit (TOP Corporation, Tokyo, Japan), in 31 patients with stroke
or hypoxic encephalopathy, between November 2001 and October 2003 at Kanazawa Medical
University Hospital.
Figure 1 Three-point triangular fixation of stomach to abdominal wall with a commercially available
fixation kit, in a percutaneous endoscopic gastrostomy (PEG) procedure (intragastric
view).
The presence of complications following PEG was retrospectively analyzed by reviewing
the hospital medical charts. The complication rate following the PEG with a triple
gastropexy was compared with that following PEG without gastropexy (n = 10). No adverse
events, including peritonitis or hemorrhage, were observed during the follow-up period
after the PEG with three-point fixation, except for transient mild fever (less than
38 °C) in two patients. On the other hand, subcutaneous abscess (complication rate
40 %) and gastric ulcer caused by the bumper on the mucosa (20 %) were observed in
the patients who underwent PEG without gastropexy. Using the three-point fixation
method, we were able to obtain a minimal distance (30 - 40 mm) between the stomach
and the abdominal wall, and it appears that this mainly contributed to the lower occurrence
of complications following PEG.
Our results suggest that three-point triangular fixation of the stomach to the abdominal
wall in the PEG procedure might establish a safe route for tube feeding. Future studies
with larger numbers and nonselected patient groups, and with long-term follow up,
are needed to clarify the possible advantage of this method.
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