What is a Gastrostomy?
A gastrostomy is pathway into the stomach through the abdominal wall. A small device (often called a button or PEG) is placed through, allowing parents and caregivers to provide essential nutrition, fluids, and medications directly into the stomach without needing to rely on oral feeding.
It is often used as a long-term alternative to a nasogastric tube in children who cannot safely swallow enough food to be able to grow.
The goal of a gastrostomy is to ensure your child receives the necessary nourishment to support their growth and development in a safe and effective way.
Is a Gastrostomy the Same as a PEG?
Not quite. The terms PEG, gastrostomy, and button are often used as if they are the same, but technically they mean different things.
A PEG refers to one of the many techniques to make a gastrostomy. So not all gastrostomies are PEGs. It stands for Percutaneous (through the skin) Endoscopic (telescope into the stomach) Gastrostomy. Different techniques have different healing times and complications, so we pay attention to those differences. We do not perform PEGs, but rather a surgical gastrostomy.
A gastrostomy is just a way to connect the stomach directly to the abdominal wall. Once made, a device needs to be placed through the connection to prevent it from closing (like studs after ears are pierced). That device might be a button, or a tube. To make things even more confusing, the button is often called a PEG.
Formation of Surgical Gastrostomy In Children
Gastrostomy surgery is a procedure performed under general anaesthetic. The surgeon uses laparoscopy (keyhole surgery) to find the stomach and secure it to the abdominal wall. The feeding device (a gastrostomy button or tube) is then placed into the stomach through the opening.
The wound is closed with dissolvable sutures, and there are sutures that hold the button in place for 1-2 weeks.
After the procedure, your child will be in the recovery room for monitoring, and you will be able to join them shortly after they wake up.
Education is required before the operation, and support is required afterwards. We often work with the team at Children’s Nursing Queensland for this service. Please note there is a fee for their service, that may be covered by your child’s NDIS package.
How Long Does the Operation Take?
The surgical procedure takes around 30 minutes, but the overall process, including anaesthetic time, and waking up in recovery, can last well over an hour depending on the condition of the child.
Often, an adult caregiver can stay with their child in the operating room until they are anaesthetised. They will then be escorted back to the waiting area to allow the operation to proceed.
You will be away from your child until they are ready to be seen in the recovery room. You’ll be notified just as they are waking up so you can be with them as early as possible.
What Are the Risks of the Operation?
Like any surgery, forming a gastrostomy comes with some risks. However, the surgery is straightforward and serious complications are very rare.
- Anaesthetic Risks: Airway and breathing issues are extremely rare.
- Bowel Injury: In rare cases there is injury to the bowel or stomach, which may require further surgery.
- Infection: The risk of infection is around 15%. There is much care and attention required after surgery.
- Leaking: In the initial few months, it is very common to have some leaking from the stomach. This can be annoying, and cause irritation of the surrounding skin.
- Conversion: Very rarely, the operation cannot be completed laparoscopically (difficult / dangerous / unsuitable). A small incision is made in the abdomen (opening the abdomen) to complete the procedure. They may end up with a tube instead of a button temporarily.
- Bleeding, Bruising, and Swelling: These are common minor side effects of surgery and typically resolve without issue.
- Granulation tissue: In some cases, there is overgrowth of healing tissue at the site of the button, which can bleed and have a yellow / cream discharge. This may need topical treatment, and occasionally requires a small visit to the operating room for removal.
What to Expect After Surgery
Once the operation is finished, your child will be taken to the recovery room. You will be able to join them shortly after they wake up. Most children recover quickly from anaesthesia.
Feeding plans are made with you and your treating team. The stomach will need some rest for a few hours, and if a nasogastric tube is already in place we will be able to check safety before starting feeds.
Your child can usually go home with you the day after surgery, once the nursing team ensures they are feeding well, comfortable and safe.
Caring for the Wound and Dressings
After surgery, there will be a waterproof dressing over the incision site in the umbilicus, and the gastrostomy site. Depending on the plan, the gastrostomy may already be connected for access to drain or feed.
The areas may become a bit swollen or firm, which is a normal part of the healing process as scar tissue forms. The scar will initially appear dark red but will fade over time.
Removing the dressing: The dressing can be removed after one week. This is usually done with the stomal therapy nurses.
Bruising and Swelling: It is normal to see some bruising and swelling around the incision site. This should improve within a few days.
Pain Relief After Surgery
Your child will receive good pain relief during the operation, and this should last for a few hours afterward. Once at home, you will need to give your child paracetamol (e.g., Panadol) and possibly ibuprofen (e.g., Nurofen) for a few days. Your child may have other conditions that require a different regime for medications. Please let your surgeon and anaesthetist know if your child has intolerances or allergies to particular medications.
It’s also helpful to distract your child and keep their mind off the surgery site. Activities like reading, playing board games, or other quiet, engaging tasks can help ease discomfort and take their mind off the area.
When Can My Child Return to Normal Activities?
Your child can return to normal daily activities fairly quickly after surgery, but some restrictions will apply:
- Bath or Shower: After a few days. They will need sponge baths in the meantime.
- Swimming: Usually after 1 week, however this is planned with your surgeon and stomal therapy nurses.
- Daycare/School: We will make a plan with you depending on the needs of your child.
- Sports or Physical Activity: We will plan this based on any special needs for your child.
Troubleshooting Common Concerns After Surgery
Is there a wound infection?
Infections are uncommon but can occur 2-4 days after surgery. Signs of infection include:
- Increased redness or tenderness around the wound.
- Discharge from the wound site.
- Fever or general unwellness.
If you notice these signs, contact your paediatric surgeon or family doctor for further advice.
Has the button dislodged?
Some swelling is normal after surgery, but if your child experiences increasing pain, tenderness, or vomiting, this could be a sign the button may have been dislodged or pulled out by accident.
If the button falls out completely place a simple dressing over the hole.
These issues require urgent attention. Either contact your surgeon or go to the emergency department.
Do not wait until the next day, as the hole closes over quickly (several hours). The longer its left, it becomes increasingly difficult to replace the button
After surgery, what symptoms might be cause for concern?
You know your child best, and if something doesn’t seem right, it’s always best to seek advice. Here are some key symptoms that require medical attention:
- Increasing pain or pain that doesn’t improve with pain relief.
- A new or increasing bulge in the area.
- Fever over 38.2°C.
- Vomiting or trouble feeding.
- No bowel movements after three days.
- Any discharge or bleeding from the wound.
- The button fell out.
If you notice any of these symptoms, contact your surgeon or family doctor.
Frequently Asked Questions (FAQs) About Gastrostomy Surgery in Children
Does my child need a gastrostomy?
This is a complex question that requires planning and thought based on the specific conditions of the child.
In short, if there is no other way to feed them, then a gastrostomy is a reasonable option.
How long does the surgery take?
The surgery itself typically lasts about 30 minutes. However, including anaesthetic and recovery time, the entire process will take around an hour. You will be able to see your child in the recovery room once they wake up.
Is gastrostomy surgery safe for children?
Yes, in general, the surgery is safe, however your child may have other conditions that make the anaesthetic more complicated. This is taken into account when deciding whether to proceed with the gastrostomy.
Will my child be in pain after surgery?
Your child will receive pain relief during the surgery, and most children experience only mild discomfort afterward. Over-the-counter pain relief like paracetamol or ibuprofen can help manage any post-surgery discomfort.
How long will it take for my child to recover?
Most children recover quickly and can return to normal activities, however some children have special needs or conditions that may prolong recovery time.
What should I do if my child has a fever or is in pain after surgery?
If your child’s fever exceeds 38.2°C or they are experiencing increasing pain that doesn’t improve with pain relief, contact your paediatric surgeon or family doctor for further advice.
What are the signs of a wound infection?
Signs of a wound infection include redness, tenderness, or discharge from the wound. If you notice these symptoms or your child is feeling unwell, contact your paediatric surgeon or GP immediately.
What should if the button falls out?
This is uncommon, however sometimes it gets caught on clothing or your child may pull it out.
If the button falls out completely place a simple dressing over the hole.
These issues require urgent attention. Either contact your surgeon, stomal therapy nurses or go to the emergency department.
Do not wait until the next day, as the hole closes over quickly (several hours). The longer its left, it becomes increasingly difficult to replace the button
When should I seek emergency medical attention?
You should seek emergency care if your child is experiencing any of the following:
- Persistent or increasing pain despite pain relief.
- A new or increasing bulge in the groin.
- Fever over 38.2°C.
- Vomiting or difficulty feeding.
- No bowel movements for more than 3 days.
- Discharge or bleeding from the wound.
- Button fell out.
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