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A gastrostomy is a surgical procedure to create a small opening via the body wall into the stomach, usually for the placement of a feeding tube. A gastrostomy tube allows a patient with a poor appetite to be fed, with a minimum of distress. It also allows the cat to eat freely should they wish, hence making it clearer when it is time to remove the tube.
Gastrostomy is performed under general anesthetic, and the tube can be placed during an exploratory laparotomy or in a minimally invasive way via an endoscope. The latter may require referral to a specialist surgeon with access to sophisticated equipment.
The patient is stabilized before the anesthetic. If the cat requires a laparotomy, then the hole into the stomach wall is made 'hands on' by the surgeon isolating the stomach, making a small stab incision and passing the tip of a special feeding tube into the body of the stomach. The tip of the feeding tube is then inflated so that it balloons out and is too large to pull back through the hole.
A small incision is made over the corresponding area of body wall and the tail of the feeding tube placed through. Any slack is taken up, and then the free end of the tube sutured to the outside of the body to keep it in place. The abdomen is then closed, and a dressing applied over the end of the tube.
A similar, but less invasive procedure can be performed endoscopically. This involves passing an endoscope from the mouth down into the stomach. From the outside the surgeon feels for the head of the endoscope pressing up against the body wall. They then make a stab incision through both the body and stomach wall. The endoscope then grasps the feeding tube and pulls it into the stomach. The end of the tube is inflated, and the tail secured to the body wall.
Gastrostomy is a highly effective way of getting nutrition into a patient that cannot or won’t eat. Maintaining food intake leads to swifter recovery times, happier cats, and arguably lower costs as the patients tend to respond better to treatment.
Feeding tubes can be put in place in the nose, esophagus, or stomach, and each method has its drawbacks and benefits. The major benefit of a gastrostomy tube is that it is relatively large bore, which allows a greater range of foods to be given. In addition, they rarely clog, and are suitable to be left in place for months and even years.
Performing a gastrostomy endoscopically is minimally invasive and patients recover very quickly from the procedure. Those placed via laparotomy require the cat must rest for 10 to 14 days until the abdominal wall has healed and the skin sutures are removed.
Patients that undergo gastrostomy are usually unwell to start with. Tube placement helps keep their strength up so although it isn't a direct treatment, it's an important part of supportive care to aid recovery.
Gastrostomy requires general anesthesia, which in a sick cat, requires supportive care such as intravenous fluids ($45 upwards) with the anesthetic itself being a minimum of $80 upwards.
Endoscopic placements may require referral to a specialist center where the cost of a consultation alone can be $225. The anesthetic and gastrostomy is likely to be in the $600 to $700 bracket upwards.
The importance of a cat receiving ongoing nutrition cannot be underestimated. A cat that can't or won't eat soon starts to lose weight and muscle mass and their protein levels drop, which impairs the body's ability to heal. Also, cats are prone to a complication called hepatic lipidosis whereby the liver gets flooded with fat.
Placing a gastrostomy tube provides an easy way to provide the cat with liquidized food, and keep up a good input of nutrition, to strengthen the immune system and prevent hepatic lipidosis.
Although tube placement is costly, it can save money in the long term if the patient recovers more quickly. Plus, once in place the tube can be left for months or years, meaning it can be a long term solution for the cat with health issues that won't eat.
One common reason for gastrostomy is to place a tube in a cat with a fractured jaw as a result of a traffic collision or fall from a balcony. Keeping a cat indoors and securing the balcony go a long way to prevent the need for gastrostomy.
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