Crew's G-Button Surgery... a long explanation

So last weekend, Friday the 30th, Crew went in for a laproscopic gastrostemy - a.k.a., G-Button placement. The NG tube that he has had going down through his nose and into his stomach was only ever intended to be a short-term thing. Since he has proven several times during swallowing studies that he cannot swallow safely (it's hard to swallow with your tongue sewn to your lip), the doctors determined that he needed a longer-term solution to his eating difficulties. Hence the G-button placement.

We went in at 9:30 in the morning. We did the usual paperwork and then poor Crew had to have blood drawn (to make sure his levels were okay for surgery/anesthesia). Then we had to wait for a couple of hours. Finally at 1:00 pm they came to get us and Crew got to wear this cute little gown. (Not that cute really but the idea is pretty cute.)



All went well during the surgery. We had a great surgeon and great anesthesiologist who made us comfortable. He was in surgery for about 40 minutes to an hour (about 20 minutes of that was spent on his circumcision ... did I mention that? Lucky kid, what little boy gets to be on morphine after a circumcision. All the male readers are thinking LUCKY? Yeah right.) Once Crew was in recovery they came and got us and I got to hold him while he was in there. He was a bit upset but calmed down pretty soon once he was cuddled a little bit. While Shawn and I were sitting with him, they wheeled in a little 2 year old boy who was inconsolable. He was so upset. The nurses said that all babies and toddlers are really upset when they come out of anesthesia - that it makes them angry. They hurried and got the mom but he was still so upset. It broke my heart. I actually started crying watching this little boy because I was picturing Mia coming out of surgery and being so confused and everything else. I personally think they should have the parents waiting in recovery so the child doesn't have to wait for them to be fetched.

After being in recovery for about an hour we were wheeled up to Crew's room. It was a private room with a full-size pullout couch bed for me. Much different than our NICU experience. Crew fell asleep and proceeded to sleep most of the next 24 hours. He didn't get to eat until the next day so I was glad that he was sleeping. I stayed overnight and Shawn went home to be with Mia.

So this is a picture of the G-Button itself along with a clear tube that attaches to it for feeding. The tube locks in and is designed to be removed when not being used to feed the child. It is currently attached so that the stomach could drain any excess fluids so he wouldn't get sick. (This tube plays an important part in the weekend's drama...read on for a further explation.)


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A brief explanation on the g-button placement: the surgeon puts a camera through Crew's belly button to make sure they are putting the button in the correct place. They fill the stomach full of air. Then they put a needle down into the stomach (watching with the camera to make sure they are in the right spot). Once it's in the right spot they slide a wire down next to the needle then pull the needle out. They then slide a dilator over the wire, and then more and more dilators, constantly getting slightly larger so it stretches the opening. Once it is about the size of maybe half the diameter of a pencil, they slide the button in. It's a tube that leads from the outside of the stomach to the inside. On the inside is a deflated balloon. Once it's slid inside the stomach, they fill the balloon with water and that is what keeps the tube from sliding out of the stomach. On the outside is a little cap over the tube to keep the stomach from leaking/emptying. (The cap is open in the picture above (because the tube is attached) and is hard to see, but it is a clear looking little flap to the left of the button.)
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So Saturday morning we started to feed Crew again (half of his normal amount to make sure his stomach could handle it). We use a feeding pump with a long tube that connects to the short tube that is shown in the picture above. We fed him again at 10:00. After his 10:00 feeding, the nurse was busy so I didn't call her in to separate the tubes and remove the tube from his button. I was holding him so I separated him from the pump but wasn't comfortable messing with the button too much yet so I left the short tube attached to the button (show in above picture). After Crew fell asleep I went to put him in his crib. I checked all of the wires and thought I was clear not to pull anything out/off. I went to lay him down and just as I was setting him down, he started to wail, I felt a little pull and then I heard a POP sound. I looked down thinking "crap, I've probably pulled out his IV." But no. It was a THOUSAND TIMES WORSE. It was his g button. It was lying on the bed. There was a large hole in Crew's stomach pouring milk and gastric juices and a little blood (thank heavens not much blood). I freaked out. Okay, I couldn't really freak out because I needed to get help and there wasn't time for that. So I put a blanket over the hole and applied pressure meanwhile having a split-second debate in my head about which button to push for the nurse... the big red button that I had been shown upon our arrival and instructed that "this was for emergencies only"..."do not push unless it is a real emergency because EVERYONE will come running." This was an emergency right? I had just ripped a hole in my son's stomach! Of course, his heart was still beating and he was still breathing and really wasn't even crying that much. Or should I hit the normal call button? I hit the BIG one, the true emergency one. Then I changed my mind. I flipped it off and hit the normal call button and then rapidly said that I had pulled out his G-button and needed my nurse NOW. Don't worry - all this indecisiveness only took 1/8th of a second or less. The nurse rushed in while I held out the g-button to her. "I pulled it out!" was my anguished explanation. I was very impressed. She stayed very calm (you can always count on nurses for that). The nurse put a dressing over the hole and taped it up then went to go call the surgeon and see what we should do. Fortunately for me, the guilt-ridden mother who had just increased her son's pain, increased the trauma of the site, just ripped out the entire purpose of the previous day's surgery and, not to mention, ripped open a hole that before this had been half the size of a pencil and was now the size of a 45 mm bullet...fortunately for me, Crew fell asleep. I was horrified and sick to my stomach. Not only because I don't do well with blood, gore and wounds, but mostly with the knowledge of what had happened. What had happened? When I leaned over to put Crew in the bed, the little clear tube that would normally have been removed but handn't been got caught between me and the crib. When I set him down I pulled it out. Fortunately, Shawn was already on his way when all this happened and was there not 15 minutes later.

Sleeping peacefully, thank heavens...

Size of G-Button (and the new hole):

After speaking with the surgeon ourselves, we were sent down to Radiology and they inserted a G-Tube (shown below) with the idea that it will keep the hole open but allow it to heal for the next 2 weeks or so and then we'll be able to switch it out for a new G-Button on an outpatient basis. So after this was inserted (without needing anesthesia and Crew did great) we went back to no eating for anther 24 hours. He started eating Sunday night but then was throwing up (not spitting up) after each feeding so they wanted to keep him even longer to make sure he could eat and keep it down. So we went home Tuesday morning.























We are now home and since have had no more drama, thank heavens. But I will say, that we are especially careful not to tug on any tubes!