The non-refluxing gastrostomy: an evaluation.

A gastrostomy is often essential to deliver adequate and safe nutrition. Various types are now available such that the technique can be tailored to the specific needs of the patient. This paper explores the non-refluxing gastrostomy for long-term intermittent gastrostomy feeding, avoiding the need for a permanent indwelling appliance. A full-thickness vascularized flap based on the right gastroepiploic vessels is raised from the greater curve of the stomach. The proximal half of the tubularized flap is buried in a submucosal tunnel and the free distal end is brought to the skin surface as a catheterizable stoma. Fifteen children with varied mental and physical disabilities formed the cohort of the study. There were 3 stomal stenoses and 3 mild mucosal eversions requiring minor surgical adjustments. One child had a wound dehiscence 10 days postoperatively. Once the stoma had healed, the majority fed by intermittent catheterization and bolus feeds at conventional feed times during the day. Intermittent catheterization was painless and easy and was well accepted by caregivers and patients. Perhaps the most important advantages were the increased patient and caregiver confidence and independence, as well as the reduction in anxiety and hospital attendance.