Longstanding GT sites may leak and become painful and nonfunctional, requiring revision. This can be complex and difficult with closure of the old gastrostomy site, placement of a new gastrostomy in the stomach, closure of the old GT site, and selection/creation of a new skin exit site.
Here is a simple method for creating a new site and closing the old one.
Place a right angle or curved tendon grasper through the old site and push up from inside the stomach towards the skin where the new GT site is to be located. Incise the skin and use the cautery to open the fascia to allow the tip to pop out though the skin.
Pull an 0-silk through the tract by grasping it in the middle to form a double-stranded loop.
The One step button is selected after measuring the abdominal wall thickness. To do this, grasp the string tightly and pull up until the clamp is pressing on the inside of the stomach under the new exit site, mark the skin level on the string, pull back with the clamp, and measure from your mark on the string to the clamp.
A Malecot or mushroom tip catheter can be used as well.
The loop in the One step is looped through the silk tie’s loop, and the the catheter/button pulled from the old GT site through the new site. After ensuring good position, the sheath is pulled off.
A standard closure of the old site is performed. We sometimes use an endostapler to close the tract.
The old site is usually closed (slightly less than completely) with a purse-string technique. A contrast study can be done to verify position, if desired. The final result: