PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
A PEG IS A WAY OF INTRODUCING FOOD, FLUIDS AND MEDICINES DIRECTLY INTO THE STOMACH BY PASSING A THIN TUBE THROUGH THE SKIN AND INTO THE STOMACH.

Indications:

A PEG tube bypasses the throat and gullet and can therefore be used for people who have difficulty with swallowing or if there is a risk of the food going “the wrong way” into the lungs. Although this can also be achieved by passing a thin tube via the nose and into the stomach, for people who need tube feeding for long periods of time, a PEG is more comfortable and easier to manage at home. PEG tubes are also more discreet as they can be tucked away under your clothes, no one needs to know you have one unless you choose to tell them.

Procedure:

A mouth guard will be put into your mouth to protect you biting your tongue or the endoscope which is a thin black tube containing a camera and a light. The procedure is mostly done under general anaesthetic. The endoscope is passed through the mouth guard, down the oesophagus and into the stomach to localize the position of the PEG on the inside. An antiseptic solution is used to clean the skin. A local anaesthetic is used to numb the area where the PEG tube will be placed, a needle is then inserted through the tummy wall into the stomach. The PEG is inserted along the needle tract. A small disc or balloon on the tip of the PEG keeps the tube from being accidentally pulled out as indicated in the diagram. Another  disc on the outside anchors the tube to hold the stomach close to the abdominal wall to prevent spillage into the abdominal cavity. Sometimes a small dressing is placed over the tube, but this is often not needed. PEG insertion usually takes 20-30 minutes.

Please note: If you suffer from reflux or regurgitation of food or acid, it is important that you note that this problem will not be improved by having a PEG. Also note that PEG feeding will not alter the outcome of your underlying disease or condition.

Although the procedure is relatively safe and major complications are rare, there are risks involved in performing an endoscopy and in making a hole in the stomach. Should there be any major complications it might be necessary to carry out an operation to address them.

The risk of a major complication is about 3%. This includes:

  • breathing problems either during or after the procedure.
  • Injury to the small or large bowel with perforation.
  • Inflammation/infection in the abdomen due to leakage from the stomach.

There is a 0.7-2.1% risk of dying from PEG placement. Minor complications occur in about 20% of cases and are mostly related to infection around the site of the tube and leakage from the site of the tube, which can be managed mostly without further interventions.

It is important that you are aware of and understand the risks before you agree to have a PEG tube inserted.

After your consultation:

  • Obtain authorization from your medical aid and book your bed for your hospital admission.
  • Carefully read through pre-operative information provided.

Day before surgery:

  • Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist  (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).

Day of surgery:

  • Arrive for admission at indicated time on ‘Code & Consent’ sheet.
  • Change into theatre attire, remove all valuable belongings.

Approximately 30 – 45min

Duration of hospital stay:

  • It is usually only a day procedure.

Activities:

  • No intensive exercise whilst you have a PEG tube, to prevent the dislodging of the tube.

Back to work:

  • Sick leave required post-operatively is approximately 2 – 5 days in total

Dietician

We strongly recommend to liaise with your dietician with regards to specific dietary needs before or after placement of the PEG.

Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:

  • Warming devises in theatre as well as warm intravenous fluids.
  • Intra-operative pain medication through the drip.
  • Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
  • As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.
If you experience any worrisome problems, please contact the rooms during working hours or the emergency number (012) 333 6000 after hours.

Other procedures performed by Dr Jeske

ABSCESS DRAINAGE
ABSCESS DRAINAGE

A SKIN INCISION IS MADE AND THE CONTENTS OF THE ABSCESS IS DRAINED.

ADRENALECTOMY (OPEN/LAPAROSCOPIC)
ADRENALECTOMY (OPEN/LAPAROSCOPIC)

AN OPERATION TO REMOVE ONE (OR BOTH) ADRENAL GLANDS.

ANAL FISTULECTOMY
ANAL FISTULECTOMY

THE FISTULA TRACT IS IDENTIFIED AND IS OPENED ALONG ITS LENGTH, AND THE EXPOSED INSIDE OF THE TRACT IS THEN CLEANED OUT.

APPENDISECTOMY (LAPAROSCOPIC/OPEN)
APPENDISECTOMY (LAPAROSCOPIC/OPEN)

AN OPERATION TO REMOVE AN APPENDIX THAT IS INFLAMED/SWOLLEN/HAS RUPTURED/HAS FORMED AN ABSCESS.

BILE DUCT EXPLORATION
BILE DUCT EXPLORATION

THE COMMON BILE DUCT (CBD – THE MAIN TUBE CARRYING BILE FROM THE LIVER TO THE INTESTINE) IS OPENED UP. ANY GALLSTONES WITHIN THE DUCT CAUSING A BLOCKAGE CAN BE REMOVED.

COLECTOMY
COLECTOMY

AN OPERATION TO REMOVE PART OF/THE ENTIRE COLON.

COLONOSCOPY
COLONOSCOPY

AN ENDOSCOPIC EXAMINATION OF THE LARGE INTESTINE (COLON & RECTUM).

DISTAL PANCREATECTOMY
DISTAL PANCREATECTOMY

THE PANCREAS IS EXPOSED AND FREED FROM THE ADJACENT ORGANS. THE TAIL (DISTAL) HALF OF THE PANCREAS IS REMOVED. THE BLOOD VESSELS THAT GO TO THE SPLEEN PASS THROUGH THE PANCREAS. AS A RESULT THE SPLEEN ALSO SOMETIMES NEEDS TO BE REMOVED.

DRAINAGE PERI-ANAL ABSCESS
DRAINAGE PERI-ANAL ABSCESS

AN INCISION IN THE SKIN NEXT TO THE ANUS TO DRAIN PUS.

ERCP
ERCP

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY, INVOLVES PASSING A FLEXIBLE ENDOSCOPE (DUODENOSCOPE) THROUGH THE MOUTH AND STOMACH TO THE FIRST PART OF THE BOWEL CALLED THE DUODENUM.

FEMORAL HERNIA REPAIR (OPEN)
FEMORAL HERNIA REPAIR (OPEN)

AN OPERATION TO REPAIR AN AREA OF WEAKNESS IN THE MUSCLES WHICH FORM THE LOWER FRONT OF THE STOMACH (IN THE GROIN REGION).

GASTROSCOPY
GASTROSCOPY

AN ENDOSCOPIC EXAMINATION OF THE STOMACH.

HAEMORRHOIDECTOMY
HAEMORRHOIDECTOMY

AN OPERATION TO REMOVE COMPLICATED HAEMORRHOIDS (PILES).

INCISIONAL HERNIA REPAIR (LAPAROSCOPIC/OPEN)
INCISIONAL HERNIA REPAIR (LAPAROSCOPIC/OPEN)

AN OPERATION TO REPAIR AN AREA OF WEAKNESS IN AN AREA WHERE PREVIOUS MUSCLE CLOSURE HAS BEEN PERFORMED (AFTER AN ABDOMINAL OPERATION).

INGUINAL HERNIA REPAIR (OPEN/LAPAROSCOPIC)
INGUINAL HERNIA REPAIR (OPEN/LAPAROSCOPIC)

AN OPERATION TO REPAIR AN AREA OF WEAKNESS IN THE MUSCLES WHICH FORM THE LOWER FRONT OF THE STOMACH (IN THE GROIN REGION).

LAPAROSCOPIC CHOLECYSTECTOMY (GALL STONES)
LAPAROSCOPIC CHOLECYSTECTOMY (GALL STONES)

REMOVAL OF GALLBLADDER BY MEANS OF MINIMALLY INVASIVE “KEY-HOLE SURGERY”.

LIVER BIOPSY
LIVER BIOPSY

THE DOCTOR WILL TAKE A VERY SMALL PIECE OF YOUR LIVER (ABOUT 1/50,000TH OF YOUR LIVER) TO SEND FOR FURTHER TESTS.

LIVER RESECTION
LIVER RESECTION

THE SURGICAL REMOVAL OF PART OF THE LIVER.

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

A PEG IS A WAY OF INTRODUCING FOOD, FLUIDS AND MEDICINES DIRECTLY INTO THE STOMACH BY PASSING A THIN TUBE THROUGH THE SKIN AND INTO THE STOMACH.

PILONIDAL ABSCESS/SINUS EXCISION
PILONIDAL ABSCESS/SINUS EXCISION

AN ELLIPTICAL INCISION IS MADE REMOVING THE AFFECTED SKIN AND INVOLVED TISSUE OVER THE BUTTOCK CLEFT.

SMALL BOWEL RESECTION
SMALL BOWEL RESECTION

SURGERY TO REMOVE A PART OF YOUR SMALL BOWEL.

SPLENECTOMY (LAPAROSCOPIC/OPEN)
SPLENECTOMY (LAPAROSCOPIC/OPEN)

AN OPERATION TO REMOVE THE SPLEEN.

STOMA CREATION/CLOSURE
STOMA CREATION/CLOSURE

A STOMA IS AN OPENING ANYWHERE ALONG THE LENGTH OF THE BOWEL TO THE EXTERIOR SKIN SURFACE TO CREATE AN ARTIFICIAL ANUS.

TOTAL PANCREATECTOMY
TOTAL PANCREATECTOMY

REMOVING YOUR WHOLE PANCREAS, YOUR DUODENUM, A SMALL PORTION OF YOUR STOMACH, THE GALLBLADDER AND PART OF YOUR BILE DUCT, YOUR SPLEEN AND MANY OF THE SURROUNDING LYMPH NODES.

UMBILICAL HERNIA REPAIR (OPEN)
UMBILICAL HERNIA REPAIR (OPEN)

AN OPERATION TO REPAIR AN AREA OF WEAKNESS/SWELLING OF THE NAVEL (BELLY BUTTON).

WHIPPLE’S (PANCREATICODUODENECTOMY)
WHIPPLE’S (PANCREATICODUODENECTOMY)

THIS IS A MAJOR OPERATION TO REMOVE THE HEAD OF THE PANCREAS.