Futilidad en cirugía: el caso de la gastrostomía

Introduction. Nutrition has traditionally been considered a basic need and ensuring it has been assumed as a medical responsibility. The use of procedures that allow artificial nutrition in borderline clinical situations is questioned, in which their benefit may be limited or null. The present study seeks to determine the success of a surgical procedure, gastrostomy, from the perspective of benefit to the patient and, thus, to approximate a definition of futile gastrostomy. Methods. An observational, retrospective and analytical study was carried out, based on the review of the medical records of patients undergoing open or endoscopic gastrostomy at the Hospital Universitario San Ignacio. The group of main researchers analyzed data to determine if the gastrostomies performed were futile or not. Results. Results. A total of 145 patients treated during the period from 2015 to 2018 were included, and 53% of whom met the criteria to consider the procedure as futile. The procedures - 108 endoscopic and 37 open - were practiced mainly in patients with head and neck malignancies, and neurological diseases. Although there was no mortality associated with the procedure, 26 of the patients died in the first 15 days after the intervention. Discussion. Determining under what conditions a gastrostomy should be considered a truly beneficial intervention is challenging. It is necessary to incorporate an ethical analysis, before offering this procedure, in order to minimize unnecessary gastrostomies that currently constitute a global problem.