Laparoscopic gastrostomy using T-fasteners as retractors and anchors

Most feeding or venting gastrostomies can be placed percutaneously via gastroscopy. Laparotomy is required if gastroscopy is not possible--for example, in patients with esophageal strictures or large tumors. We have developed a new technique of laparoscopic gastrostomy, and used it successfully in three patients. The key to this technique is the T-fastener, a nylon suture attached to a metal T-bar, which is introduced via a slotted needle percutaneously and dislodged inside the stomach lumen. Four T-fasteners secure the stomach wall to the anterior abdomen. A balloon catheter gastrostomy tube is then placed over a J-wire through the center of these T-fasteners. This technique requires no gastroscopy or intracorporeal suturing and needs only one port for the laparoscope. It is safe and simple and can be used for patients who require a gastrostomy in whom gastroscopy is not possible or is risky.