When you or your child's condition improves and you are able to eat orally, it may be time to consider G-tube removal.
Requirements for G-Tube removal
Generally, based on the diagnosis and other existing conditions, a doctor will have established criteria necessary to have a feeding tube removed. Most must eat fully and take medication orally for at least 3 months with significant weight gain. Some may require 6-12 months of non-use and an illness such as a cold or gastrointestinal virus to see how the patient reacts during stressful times.
Most physicians will not want to remove a feeding tube unless they are 100% certain that a new feeding tube will not need to be re-inserted. If your child gets sick and doesn't eat for a week, it could start a downward trend.
In some cases, consistent weight gain and an increase in weight percentile is required.
If you are unsure of the requirements to have your or your child's G-tube removed, you will need to call your care team and discuss the necessary steps.
The 3 most common ways to remove a G-hose
There are 3 ways to have a G-tube removed and it's best to think of them as rungs on a ladder.
Most doctors will start with the first, then move on to the second, and if that still doesn't work, surgically remove the G-tube.
1. G-tube removal at home
Removing a G-probe at home is the easiest way to remove a G-probe. After getting the doctor's approval, simply remove the water from the balloon and remove the G-tube.
This is very similar to replacing a g-tube at home, except you don't put a new one in.
After removing the tube, you can put split gauze over the site and use tape or a bandage to hold in place.
Every body reacts differently to the way it heals. Some stomata begin to close immediately, others may take a long time.
Slight leakage or leaking is considered normal for the first few days after removal. If you notice any irritation, read our article aboutSkin damage to get some helpful tips.
Your doctor may advise you not to submerge the area in water for a few days, so you can usually rinse it off in a shower or do a couple of sponge baths to stay clean.
If the G-tube site starts leaking profusely and shows no signs of slowing down, you need to let your doctor and healthcare team know.
Keep in mind that if the site is already prone to leakage, removing the G-tube will likely continue to leak stomach acid and contents onto the skin. This can cause a lot of irritation and damage to the skin. Make sure your care team is informed if the site is leaking.
My daughter has always had problems with leaks and when we removed the G-tube every time she ate or drank everything came out of the hole onto her tummy. This resulted in severe skin damage.
After 5 days we had no choice but to reinsert a replacement G-tube into the stoma until we could get an appointment with our surgical team.
2. Stitches to close a G-tube stoma
If the G-tube site is consistently leaking after 4-6 weeks, or if everything that was ingested is leaking out of the stoma, the next step is to try suturing the opening shut.
Your doctor or surgeon will place stitches in the stoma to help the wound heal.
As with all stitches, you will usually be told not to submerge the area in water and avoid getting the area too wet.
After the stoma is sewn, you may experience pain or discomfort for a few days. Usually, over-the-counter pain relievers like Tylenol are sufficient for the pain.
The stoma may leak or ooze for a few days after the stitches are placed. The goal is to bring the sides of the stoma together to close the opening and heal your body, but this isn't always the case.
On my daughter, the surgeon sewed and cauterized some granulation tissue to try to heal the stoma.
The site looked wonderful and there were hardly any leaks for the first 48 hours. By the second day she was back to her normal active self and that's when our problems started.
Every time she ate or drank, it looked like a faucet poured everything onto her stomach.
We tried pressure bandages, held pads to her stomach with ace bandages, and tried to keep her skin from burning from all the stomach contents.
To be honest I was so frustrated at this point because removing a G-probe is supposed to be a happy time and that was just miserable.
So after a few days of no improvement we put in a replacement G-tube until her next procedure which is a month from now.
I was very surprised that I was able to plug it back in without any problems. I think all the leakage had started to unravel the stitches set.
At that point, our surgeon agreed that it needed to be surgically closed.
3. Surgical removal of the G-tube
During the surgical removal of a G-tube, a surgeon goes into the stomach and removes the fistula that connects the stomach to the stoma.
Most surgeons do not perform complete removal of the site unless a stoma refuses to close after months of Gtube removal or when skin damage is causing major problems.
In our case, it took more than 2 months from the time we received clearance to remove the G-tube to surgically occlude it.
We were able to go home after our procedure but sometimes an overnight stay may be required.
The picture below is 36 hours post-op when we performed her first dressing change.
We continued to use apadded belly bandfor the first few days because our daughter kept trying to play around with her bandage/dressing. We didn't want her to accidentally cause any problems, so we thought it best to "hide" her incision site for a few days.
She experienced discomfort and pain for a few days when she sneezed, laughed too much, or coughed, but this is considered normal.
After 4 days we were able to remove the bandages and she was back to normal with no more discomfort.
During this time I was informed by several different staff at our local hospital that the reason they do not automatically surgically remove the G-tube is for insurance reasons and in case a G-tube is needed later.
Apparently most insurance companies want you to try all non-invasive measures first before approving surgery to close the G-tube. That makes sense in a way, but if you already have a leaky G-tube it seems very cruel to put a child through all of the skin damage just to see if it closes on its own. Unfortunately, this appears to be a costing measure for the insurance company and not based on medical opinion.
If a G-probe site already has issues with leaking or granulated tissue, you are much more likely to need a surgical closure.
If your g-probe has never had leaking or granulation tissue, then chances are very good that it will close on its own and it should heal within 2-8 weeks.
If another G-tube is needed later, complete removal of the tract/fistula can take a few months to fully heal, making it much more difficult to place a new feeding tube later.
Surgical removal is always a last resort and is rarely, if ever, done immediately.
Aftercare for G-Tube removal
Aftercare for a G-Tube removal is very simple. It's mostly about changing dressings and keeping the area dry.
You can shower again after a few days, and fully immerse yourself in a bath after a few weeks.
If at any time after surgical removal you notice redness, swelling, or pus around the incision, you must tell your doctor.
Due to the location of the incision, exposure to stomach acid/stomach contents, and other risk factors you may have, infection in the former g-tube area can be fairly common.
If an infection is present and caught early, it is usually cleared up fairly quickly with antibiotics.
After 7 days, the area is usually no longer painful or uncomfortable. Typically you will see a slight scabbing and the wound healing.
Does G-Tube Removal Leave Scars?
When the G-probe is removed you will usually see a scar in its place. Scarring is completely different for everyone because we all heal at different rates.
Some people have a small needlestick scar that is very minimal.
Others have a button scar called a keloid. This is a lumpy or rigid scar that is slightly raised. Some refer to this scar as their second belly button.
Keloid scars are not harmful and do not require further treatment. If you're not happy with the appearance of your keloid scar, a doctor can sometimes minimize its appearance.
When your G-probe is surgically removed, you typically have a 1-inch scar across the area.
The following picture is a week after the surgery and the site is healing well.
Der Tubie-Absolvent
Depending on why you had the g-probe, removing your g-probe can be a major accomplishment.
In many cases, a child has overcome learning to drink and eatoral aversion, or had many surgeries.
We gave our Tubie Graduate a very special treat! We offered ice cream and a cupcake but she only wanted goldfish crackers. So we toasted our goldfish crackers and celebrated.
For us, the removal of our G-tube meant that we could finally lead a more normal everyday life. We struggled with constant leakage and skin damage as she had to have the G-tube inserted shortly after birth.
I get such a kick out of seeing her wear clothes that were never an option before. I'm also relieved that I don't have to do as much laundry anymore! There were days when I had to change them every hour because of all the leakage.
With the joy and excitement comes some fear. Fear of what if she stops eating, what if she starts to lose weight, what if she has complications from esophageal atresia and needs a feeding tube again.
I think part of those feelings will be due to thatPost-traumatic stress disorder, and part is just the normal concern of parents.
For now, I choose joy and look forward to our next chapter in the journey.
Applause!