The G tube surgery can be performed in three ways:
surgically through small incisions using a laparoscope
surgically using a larger open incision
endoscopically using a scope into the stomach to create the stoma from the inside
The endoscopic method has become the method of choice at many hospitals; however, some institutions still place tubes surgically, and children with anatomic abnormalities or needing multiple procedures may require a surgical placement.
From NG-tube to G-tube
Parents and caregivers are often concerned about moving from an NG- to a G-tube. It can feel like a big step, and it seems more permanent because it requires a surgical procedure. But, understanding more about it from other parents who have been through it can help a lot. Download our handout for more information.
A very common response to switching from NG-tube to G-tube is “I wish we had done it sooner!” Most families find the tube much easier to use, more discreet, and more comfortable for their child.
Benefits of Switching to a G-tube:
The G-tube is a more comfortable tube for children once the stoma (tube site) is healed. Infants and children pull out their NG-tubes with frequency, but it is rare for a child to repeatedly pull out the G-tube. Moreover, for children who have allergies or sensitivities to adhesives, taping isn’t usually required, and there are alternatives like protective belts and wraps if needed.
G-tube changes are less traumatic for children than NG-tube changes, and they happen less frequently. Changing a G-tube can become as easy as changing an earring.
There is less risk of misplacement. Once the stoma is formed it is very difficult for a G-tube to dislodge or get displaced.
G-tubes allow for venting the stomach to get out excess air. This can make it more comfortable for the child and improve tolerance of tube feeds and oral eating.
Usually, surgeons prefer you to wait a week or two before submersing the G-tube site in water. In the meantime, you can use a swab, gauze, or washcloth to gently clean the tube site. Your surgeon may have specific recommendations for cleaning the site at first.
Hospital Stay and Recovery
Your child will likely only need to be in the hospital for a day or two, depending upon how well he tolerates his feeds after, as well as your familiarity with tube feeding. The stay will be longer if a Nissen fundoplication is also performed.
Some hospitals will give Tylenol for pain, some Tylenol with codeine, and some will give narcotics. It depends on the specifics of your child’s surgery and surgeon preference.
The nurses or someone from your DME supply company should train you on how to do everything before your child is discharged. Be sure to try everything yourself, and to ask lots of questions to make sure you are comfortable.
Your child’s tummy may be a little sensitive for a while, maybe up to a few weeks. But once the stoma has healed, your child should be able to do tummy time again with no problems.
What to Bring to the Hospital
Small toys and DVDs. Nearly all hospitals will have access to some type of DVD player. Child Life staff will also have toys, games and DVDs available.
Overnight diapers and wipes. Hospitals typically don’t carry overnight diapers. If your child needs them, make sure to bring them. Nurses will let you use overnight diapers as long as you have an extra one for them to weigh if they need to monitor output. Surprisingly enough, not all hospitals have wipes, and even if they do, they are usually poor quality. You may want to bring your own.
Formula and medications. Contact the hospital in advance to find out if they stock your exact formula, as well as all your child’s medications. You may need to bring formula with you. Bring your own medications just in case.
Pajamas and bedding. If your child has highly sensitive skin or severe allergies, consider bringing his or her own pajamas and bedding. Some children also prefer their own familiar items.
Slippers and comfy clothing for you.
Snacks or food for you. There should be a community fridge, or possibly one in your child’s room. You won’t always have time to run to the cafeteria.
Something light to read. If your child is going to be sleeping a lot, you will need something to do. But you will likely be interrupted often by nurses or doctors checking in, so pick something easy.
Questions to Ask
Is this an open or laparoscopic surgery procedure or will it be performed by endoscope? Why are you choosing to do it that way?
Will you be doing a fundoplication? If so, will it be a full Nissen or partial fundoplication? Why or why not?
Will my child be receiving a long tube or a button? Will it be a balloon tube or a non-balloon device? Why are you recommending this type of tube? If you are recommending a long tube, when can it be changed to a button?
What is your plan for pain management after surgery? What pain meds will be given, and how will they be given? NOTE: Adequate pain management after surgery is very important and will lessen recovery time. Do not be afraid to be an advocate for your child to make sure pain is well controlled. Having a plan ahead of time is especially helpful.
What should my child expect as far as recovery? How long do you expect my child to be in the hospital?
How soon after surgery should we expect to start feeding through the tube?
Who will determine the feeding plan, and can I be a part of those decisions? NOTE: Some children need to start out with slower or smaller feedings, especially if they have had a Nissen fundoplication. It is important to try to avoid retching (dry heaves) from feeding too fast, too much, or too soon.