PEXACT — direct-puncture PEG after gastropexy

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G. Schachschal, Hamburg


Sequence 1: gastropexy device

The gastropexy device consists of two hollow needles that are attached to each other. A suture thread is inserted through one hollow needle, and a snare with which the thread can be captured inside the gastric lumen is inserted through the other.

Sequence 2: first gastropexy

With endoscopic control, the anterior gastric wall is punctured with the gastropexy device. The snare is introduced through one hollow needle and positioned over the other needle. The suture thread is now advanced through the other hollow needle and through the snare. When the snare is pulled back, the suture is captured between the hollow needle and the snare and can thus be pulled through the abdominal wall. The gastropexy is secured with knots under slight tension.

Sequence 3: second gastropexy and incision

In the same way as the first gastropexy, a second suture is placed at a distance of about 2 cm away. A sufficiently large incision is then made between the two sutures.

Sequence 4: direct puncture with trocar and peel-away sheath

With endoscopic control, a direct puncture is now carried out with a trocar and an attached peel-away sheath. After the trocar has been withdrawn, the 15-Fr PEG can be advanced into the stomach and blocked with 3 mL water. The peel-away sheath is completely removed.

Sequence 5: attachment and dressing of the PEG

The PEG tube with the retaining bolster is attached under slight tension. A Metalline® pad is inserted between the bolster and the abdominal wall.

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