Leaking G-Tube Solutions

Leaking gastrostomy tubes, the hidden nightmare haunting pediatric surgeons. These tubes, often inserted either temporarily to help an infant overcome feeding aversion can become permanent fixtures in their lives, especially for those with pharyngeal dysphasia.  But what happens when the insertion site starts to leak? The consequences can be dire and the solutions are far from simple.

Families, burdened by the challenges their children already face, often hesitate to return to the surgeon's office. Their reasons are valid, lack of transpiration, time, and possibly the fear of additional surgery for their complex needs child. However, pediatric patients are a special population, and as they do what no other group does, they grow. As the child grows, the tube must be lengthened to accommodate this development as the stomach moves further away from the abdominal skin; what often happens is as the tube leaks the ballon size is increased. This worsens the leakage as the gastrostomy site is increased in size and the hole expands. This is done with good intentions, with the thought that a bigger hole needs a bigger balloon, to "plug" the site.

A leaking gastronomy site demands an unconventional approach.  Strangely enough, the answer is to remove the tube to allow the skin site to heal without a foreign body in place, so the track can downsize naturally. It is just like a new earring piercing that closes up if the earring is removed. However timing is crucial, if the tube has been in place for over 8 months to one year, the site is more likely to stay open; also if the skin is excoriated time to healing is longer, so production of the skin around the gastronomy tube is also crucial. This author prefers Marathon Liquid Skin Protectant, a no-stain cyanoacrylate product.

Eventually if after 6 weeks the site has not downsized or closed after permanent removal it is now a gastro-cutaneous fistula that must be addressed n the operating room. If the feeding tube is still needed the old site must be closed and the new gastrostomy site found on virgin skin.

In the realm of medicine, where the smallest details can have monumental consequences, we must navigate a delicate balance. The leaking gastronomy tube poses challenges that demand our attention, our expertise, and our unwavering commitment to finding innovative solutions. We owe it to these children and their families to tackle this problem head-on, to ensure that their journey towards health is not marred by the perils of a leaking g-tube.