Experience with a modified Witzel gastrostomy without gastropexy

The records of 161 adult patients who underwent a modification of the Witzel gastrostomy without gastropexy at Ellis Fischel State Cancer Hospital, Columbia, Missouri, between 1977 and 1980, are reviewed in detail and form the basis of this report. Six of these patients had gastrostomies on two different occasions. There was no mortality or major complication directly attributed to the procedure in this group of patients. Technical details are examined and considered most important in preventing intraperitoneal or extraperitoneal leak of gastric contents and migration of the catheter, the most commonly found complications of other techniques. Anterior gastropexy is considered unnecessary, thus simplifying the operation and eliminating gastric deformity and other related problems. The liberal indications of this procedure are discussed, and potential areas of technical pitfalls are reviewed. The personal experience of one of the authors (EMB) with 774 gastrostomies during a 15-year period using this technique confirms these conclusions. A random sample of 200 records of these patients were examined for complications of the operation. This study suggests that tube gastrostomy by the technique described is a reliable and safe procedure with wide applicability for patients undergoing major abdominal surgery. The relatively few complications are more than compensated for by the degree to which postoperative comfort and care are facilitated.