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.
More procedures performed by Dr Jeske
A SKIN INCISION IS MADE AND THE CONTENTS OF THE ABSCESS IS DRAINED.
THE FISTULA TRACT IS IDENTIFIED AND IS OPENED ALONG ITS LENGTH, AND THE EXPOSED INSIDE OF THE TRACT IS THEN CLEANED OUT.
AN OPERATION TO REMOVE AN APPENDIX THAT IS INFLAMED/SWOLLEN/HAS RUPTURED/HAS FORMED AN ABSCESS.
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.
PTC is a procedure performed by a radiologist (specialist X-ray doctor) who takes X-ray pictures of the bile ducts which are tubes inside the liver.
