Gastrostomy internal and external sites tips

“Placement of the Stoma Site. The stoma site on the abdominal wall should be placed away from the rib cage because, with the child’s growth, the distance between the two tends to become shorter. A gastric access device that is too close to the ribs will cause discomfort and interfere with care. Additionally, pivoting motion resulting from breathing and moving can lead to stoma enlargement and leakage. In small children, the linea alba tends to be broad and very thin and also should be avoided as an exit site. The stoma site on the stomach should be in the mid-body—away from the greater curvature, because the proximity to the transverse colon can lead to a gastrocolic fistula; away from the fundus, to allow for a possible future fundoplication; and away from the presumed site of the gastric pacemaker, near the splenic hilum. It is critical to avoid the antrum to prevent pyloric obstruction by the catheter tip and interference with gastric emptying. A stoma in this position is also more likely to leak. Placements that exert downward traction on the stomach, particularly along the greater curvature, can interfere with the angle of His at the esophagogastric junction and therefore should be avoided.”

— Pediatric Surgery (Springer Surgery Atlas) by Prem Puri, Michael E. Höllwarth