GASTROSTOMY

GASTROSTOMY 

1.) Stamm== Temporary, No formation of gastric tube or Tunnel.
2.) Witzel's == Formation of serosal or seromuscular tube or tunnel over the tube.
3.) Janeway == Mostly permanent, Formation of gastric tube/ Tunnel

These gastrostomies are fast and relatively safe & can be performed open/Stapled or laparoscopically. But now, these are mostly indicated after failed/dislodged or impossible PEG ( percutaneous endoscopic gastrostomy) & Non- availability of expertise/equipment. 

Stamm/ Witzel's  Gastrostomy:
-It is a temporary gastrostomy 
-For patients who require long-term gastric tube feeding, the Janeway gastrostomy is more convenient than Stamm.

Choose a location in the mid-portion of the stomach, closer to the greater curvature than the lesser curvature. Using 2-0 atraumatic PG or silk, insert a circular purse-string suture with a 1.5 cm diameter.
-18F to 22F Foley, Malecot/ mushroom catheter inserted (10 to 15cm)  into the stomach, tighten purse-string suture and tie it to invert the gastric serosa. Invert this purse-string suture, in turn, with a second concentric 2-0 PG or silk purse-string suture.
 -If a Foley catheter was used, inflate the balloon and draw the stomach toward the anterior abdominal wall. Insert Lembert sutures of PG or silk in four quadrants around the catheter to sew the stomach to the anterior abdominal wall around the stab wound. When these four Lembert sutures are tied, the anterior gastric wall is firmly anchored to the abdominal wall.
👉Witzel's Gastrostomy is the same except a serosal, or seromuscular tube or tunnel is made after applying purse-string sutures around the tube through the gastric opening. 
JANEWAY GASTROSTOMY;
The gastric wall is divided near the lesser curvature, and a rectangular flap is developed by extending the incision on either side toward the greater curvature. 
-After pulling the flap, the catheter is placed along the inner surface of the flap. The mucous membrane is closed with continuous suture, then submucosa and serosa are closed preferably by interrupted nonabsorbable suture. When this cone-shaped entrance to the stomach has been completed about the catheter, the anterior gastric wall is attached to the peritoneum at the suture line with a nonabsorbable suture.
The abdominal wall layers are closed about this, and the mucosa is anchored to the skin.
👉A gastric tube can be constructed with a stapling instrument.

Ref: Chassin’s Operative Strategy in General Surgery 4th edition.

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