A simple gastropexy for the loop-gastrostomy tube
A 40-year-old man, had arrested hydrocephalus since childhood. Mentally retarded, he was cared for by his mother. He had been fed orally until aspiration pneumonia precipitated his admission into the hospital. As his swallowing reflex had deteriorated, to prevent recurrence of aspiration pneumonia, his doctor recommended tube-feeding. Unfortunately, naso-gastric intubation proved to be impossible; the tube kept coiling in the throat. Thus, a gastrostomy tube was necessary. The family gave written informed consent for the loop-gastrostomy instead of a standard PEG.\nPre-procedure fasting, initial gastroscopy, skin preparation, selection of puncture sites, etc. were performed in the usual manner. Only one modification was made: prior to pull-through insertion of the tube (LOOPPEG® 3G) a secondary loop was fashioned at the mid-portion with Vicryl® (polyglactin 910) 3/O ligatures, as illustrated in . Pulling the tube ends apposed the stomach wall to the abdominal wall []. When doing so, care was taken to avoid strangulating the tissues. Then the lock was applied to the two ends as per the instructions of the manufacturer [].\nThe endoscopic view of the secondary loop in the stomach is shown in .\nThe patient tolerated the procedure well. This was to be expected because only sedation and local anaesthesia were used, as is the case for most PEG insertions. Enteral feeds were started 24 hours after the procedure and increased gradually.