Gastrostomy: Witzel’s method. Tube in position; sutures ready to close abdominal wall. (Richardson.)
Fig. 531
Gastrostomy by Frank’s method: cone of stomach stitched into the peritoneal wound. (Richardson.)
All operative methods include fixation and consequent adhesion of the anterior stomach wall to the parietal peritoneum, just below the border of the ribs. Of the many methods employed the following will be described, most of which can be easily appreciated in diagram:
[Figs. 529] and [530] illustrate, for instance, Witzel’s method, where a sterile, soft rubber catheter is infolded in the stomach wall, and finally passed into its cavity through the smallest opening that may suffice for the purpose, after which the outer layer of the stomach is completely closed over it. The stomach itself is stitched to the deep margins of the external wound, and these are then closed without drainage. If everything has been neatly done feeding may be begun within a few hours. Care should be exercised about passing into a stomach which has long been without much food a quantity which may disturb it, or of a quality which may distress it. A procedure very much like Witzel’s is that described by Marwedel, who first sews the stomach to the abdominal wound after drawing it partly into the wound, in order to afford sufficient working material, and then infolds the tube and inserts its lower end through a small opening. This is perhaps preferable, since the stomach being so fastened up at once there is no possibility of leakage into the abdomen.
[Figs. 531], [532] and [533] illustrate Frank’s method, where the stomach is pulled up through a sufficiently long incision and drawn out into a cone, whose apex is then brought out through a second small incision, parallel to the first and at a distance of an inch or so from it. Here an actual opening is made into the stomach, while the cone is fastened to the skin here and to the peritoneum through the other opening, which is then completely closed. This method cannot be applied to a contracted stomach.
Fig. 532
Gastrostomy by Frank’s method: cone of stomach pushed through the second skin incision. (Richardson.)