There are a couple of ways that a gastrostomy can be made. One is by an incision through the abdominal wall (the layer of soft tissue and muscle that covers the stomach) from just below the ribs to just above the belly button. The second is called a percutaneous endoscopic gastrostomy (PEG) and uses an endoscope to help the surgeon poke a hole through the abdominal wall into the stomach.
Because of all of the scars on Nathan's abdomen from all of his previous surgeries, the surgeon preferred to do a PEG placement instead of the surgical placement. A PEG is considerably less invasive than surgical placement as well.
To place a PEG, the surgeon passes an endoscope, a long, slender tube with a light and a video camera on the end, through the mouth and down the esophagus into the stomach. The surgeon can then look through the tube and see the inside of the stomach.
Once the endoscope is in place, the light from the endoscope is visible on the outside of the abdomen. The surgeon then pushes a hollow needle into the "light" on the skin and the abdominal wall and into the stomach. A wire is then threaded through the needle into the stomach.
When the surgeon is able to see the end of the wire with the endoscope, he will grab it with a tool on the end of the endoscope and pull it up the esophagus and out the mouth. A soft, silicone tube is then attached to the wire and then pulled down into the stomach and out through the opening in the abdominal wall. A small dome-like device on the end of the tube prevents it from pulling the stomach out the opening.
A small bolster is attached to the part of the tube next to the skin to hold it in place.
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