1
|
Castrillo A, García-Martínez L, Laín A, Giné C, Díaz-Hervás M, López M. Percutaneous Endoscopic Gastrostomy with T-Fasteners versus "Pull Technique": Analysis of Complications. Eur J Pediatr Surg 2024. [PMID: 38848755 DOI: 10.1055/a-2340-9475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
INTRODUCTION The T-fasteners gastrostomy (T-PEG) has become increasingly popular over recent years as an alternative to the "pull-technique" gastrostomy (P-PEG). This study aimed to compare P-PEG and T-PEG complications. MATERIALS AND METHODS A retrospective observational study of pediatric patients who underwent percutaneous endoscopic gastrostomy (PEG) placement. P-PEG was performed using the standard Ponsky technique and was replaced after 6 months by a balloon gastrostomy under sedation. T-PEG was performed using three percutaneous T-fasteners (that allow a primary insertion of a balloon gastrostomy). The balloon was replaced by a new one after 6 months without sedation. Complications were recorded. RESULTS In total, 146 patients underwent PEG placement, 70 P-PEG and 76 T-PEG. The mean follow-up was 3.9 years (standard deviation = 9.6). Age, weight, and associated comorbidities were comparable (p > 0.05). The overall complications were 17 (24.2%) in the P-PEG group and 16 (21.0%) in the T-PEG group (p > 0.05). P-PEG was associated with more sedation for button replacement (97 vs. 2.6% [p < 0.05]). P-PEG was associated with more early tube dislodgement during the first replacement (7.2 vs. 1.4% [p = 0.092]). Two of the five dislodged gastrostomies in the P-PEG group underwent laparotomy due to peritonitis, whereas the only dislodged gastrostomy in the T-PEG group was solved endoscopically. Altogether, P-PEG was associated with more complications that required urgent endoscopy, laparotomy, or laparoscopy (18.6 vs. 6.6% [p < 0.05]). CONCLUSIONS P-PEG was associated with more sedation, complications during first button replacement, and complications requiring urgent endoscopy, laparotomy, or laparoscopy compared with T-PEG.
Collapse
Affiliation(s)
- Alejandra Castrillo
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura García-Martínez
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ana Laín
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos Giné
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Díaz-Hervás
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
2
|
Fung ACH, Ooi YN, Hui HM, Mok MKY, Chung PHY, Wong KKY. Prophylactic anti-reflux procedure for children undergoing laparoscopic gastrostomy: Rethinking of the routine practice. World J Surg 2024; 48:739-745. [PMID: 38501550 DOI: 10.1002/wjs.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/27/2023] [Indexed: 03/20/2024]
Abstract
AIM Laparoscopic gastrostomy is a frequently performed procedure in children requiring long-term enteral nutrition. The role of prophylactic anti-reflux surgery during gastrostomy placements is controversial. The current study aims to evaluate the role of prophylactic anti-reflux procedures during gastrostomy placement. METHODS A retrospective single-center analysis of all children without reflux receiving laparoscopic gastrostomy from January 2005 through December 2021 was performed. Demographics and clinical outcomes were compared between patients receiving gastrostomy placement alone and patients receiving gastrostomy with prophylactic anti-reflux surgery. RESULTS A total of 79 patients had a confirmed absence of reflux by a 24-h pH/impedance study before operation. Thirty-six of these patients underwent prophylactic anti-reflux surgery (PAR) while 43 received gastrostomy (PG) alone. The operative time and conversion rate were significantly higher in the PAR group (140.5 ± 67.5 vs. 80.2 ± 66.8 min, p = 0.0001 and 8.3% vs. 0%, p = 0.04). There were no major complications in either group. De novo reflux was detected in five patients (11.6%) in the PG group. None of these patients progressed to require anti-reflux surgery. CONCLUSION The occurrence of de novo reflux after laparoscopic gastrostomy was low and could be managed without anti-reflux surgery. A routine pre-operative pH study is helpful for appropriate patient selection to avoid unnecessary anti-reflux surgery, which lengthens operative time and increases the conversion rate.
Collapse
Affiliation(s)
- Adrian Chi Heng Fung
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yu Ning Ooi
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ho Ming Hui
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Michelle Kam Yan Mok
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Ho Yu Chung
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Kenneth Kak Yuen Wong
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
3
|
Ishibashi S, Kumori K, Manako J, Funabashi N, Senaha Y, Hidaka M. Open Gastrostomy by Mini-Laparotomy: Our Method. Cureus 2023; 15:e45506. [PMID: 37868450 PMCID: PMC10585052 DOI: 10.7759/cureus.45506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
When percutaneous endoscopic gastrostomy (PEG) is not feasible owing to anatomical obstacles, laparotomic or laparoscopic gastrostomy (LAG) is an alternative. At our institution, LAG has been the first choice for patients who are unable to undergo PEG; however, we have introduced a small open gastrostomy through a 2-cm-long transverse incision since 2020. By December 2022, 12 patients had undergone this procedure without complications. In one case where the stomach was located cephalad to the rib arch and the patient had a round dorsum, the incision wound was extended, and a lengthy operation was required. We believe that our small-incision gastrostomy is a useful option in addition to LAG for cases in which PEG is difficult to perform. Further studies are required to determine the indications for this procedure.
Collapse
Affiliation(s)
- Shuichi Ishibashi
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Koji Kumori
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Junko Manako
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Narimasa Funabashi
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Yoko Senaha
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Masaaki Hidaka
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| |
Collapse
|
4
|
Tazi K, Kotilea K, Dassonville M, Bontems P. Complications of Percutaneous and Surgical Gastrostomy Placements in Children: a Single-Centre Series. JPGN REPORTS 2023; 4:e316. [PMID: 37200716 PMCID: PMC10187850 DOI: 10.1097/pg9.0000000000000316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/22/2023] [Indexed: 05/20/2023]
Abstract
Gastrostomy placement is a standard procedure for children requiring enteral feeding for more than 3-6 weeks. Various techniques have been described (percutaneous endoscopic, laparoscopy, and laparotomy), and many complications have been reported. In our center, gastrostomy placement is performed either percutaneously by pediatric gastroenterologists, by laparoscopy/laparotomy by the visceral surgery team, or jointly, that is laparoscopic-assisted percutaneous endoscopic gastrostomy. This study aims to report all complications and identify risk factors and ways to prevent them. Methods This is a monocentric retrospective study including children younger than 18 years who underwent gastrostomy placement (percutaneous or surgical) between January 2012 and December 2020. Complications that occurred up to 1 year after placement were collected and classified according to their time of onset, degree of severity, and management. A univariate analysis was conducted to compare the groups and the occurrence of complications. Results We established a cohort of 124 children. Sixty-three (50.8%) presented a concomitant neurological disease. Fifty-nine patients (47.6%) underwent endoscopic placement, 59 (47.6%) surgical placement, and 6 (4.8%) laparoscopic-assisted percutaneous endoscopic gastrostomy. Two hundred and two complications were described, including 29 (14.4%) major and 173 (85.6%) minor. Abdominal wall abscess and cellulitis were reported 13 times. Patients who underwent surgical placement presented more complications (major and minor combined) with a statistically significant difference compared with the endoscopic technique. Patients with a concomitant neurological disease had significantly more early complications in the percutaneous group. Patients with malnutrition had significantly more major complications requiring endoscopic or surgical management. Conclusion This study highlights a significant number of major complications or complications requiring additional management under general anesthesia. Children with a concomitant neurological disease or malnutrition are at greater risk of severe and early complications. Infections remain a frequent complication, and prevention strategies should be reviewed.
Collapse
Affiliation(s)
- Kaoutar Tazi
- From the Paediatric Gastroenterology Department, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Kallirroi Kotilea
- From the Paediatric Gastroenterology Department, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Martine Dassonville
- Paediatric Surgery Department, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Bontems
- From the Paediatric Gastroenterology Department, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
5
|
Jean-Bart C C, Aumar M, Ley D, Antoine M, Cailliau E, Coopman S, Guimber D, Ganga S, Turck D, Gottrand F. Complications of one-step button percutaneous endoscopic gastrostomy in children. Eur J Pediatr 2023; 182:1665-1672. [PMID: 36735060 DOI: 10.1007/s00431-023-04822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
To assess the complications of one-step button percutaneous endoscopic gastrostomy (B-PEG) and determine risk factors for developing stomal infections or gastropexy complications. A retrospective study of 679 children who underwent a B-PEG procedure in a single tertiary care center over a 10-year period to December 2020 was conducted. Patient characteristics, early complications (occurring ≤ 7 days after the procedure), late complications (> 7 days after the procedure), and outcomes were collected from medical records. A list of potential risk factors, including age at procedure, prematurity, underlying neurological disease, and undernutrition, was determined a priori. At least 1 year of follow-up was available for 513 patients. Median follow-up duration was 2.8 years (interquartile range 1.0-4.9 years). Major complications were rare (< 2%), and no death was related to B-PEG. Early complications affected 15.9% of the study population, and 78.0% of children presented late complications. Development of granulation tissue was the most common complication followed in frequency by tube dislodgment and T-fastener complications. Only 24 patients (3.5%) presented stomal infections. Young age at the time of PEG placement (odds ratio (OR) 2.34 [1.03-5.30], p = .042) was a risk factor for developing peristomal infection. T-fastener migration occurred in 17.3% of children, and we found underlying neurological disease was a protective factor (OR 0.59 [0.37-0.92], p = .019). Conclusion: B-PEG is a safe method and associated with a low rate of local infection. However, T-fasteners are associated with significant morbidity and require particular attention in young and premature infants. What is Known: • Percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide long-term enteral nutrition in children to prevent malnutrition. The Pull-PEG method is still the most commonly used with complications , such as stomal infection. Since its description, only a few studies have reported postoperative complications of one-step button PEG (B-PEG). What is New: • T-fastener complications were not rare, and underlying neurologic disease was a protective factor. A very low rate of stomal infection was described, and young age at the time of PEG placement was a risk factor. The B-PEG is a safe method with fewer major complications than P-PEG in children.
Collapse
Affiliation(s)
- Charlotte Jean-Bart C
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France.
- Department of Pediatrics, Children's Hospital, Roubaix, France.
| | - Madeleine Aumar
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France
| | - Delphine Ley
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France
| | - Matthieu Antoine
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France
| | - Emeline Cailliau
- Department of Biostatistics, University of Lille, ULR 2694, Lille, France
| | - Stéphanie Coopman
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France
| | - Dominique Guimber
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France
| | - Serge Ganga
- Department of Pediatrics, Children's Hospital, Roubaix, France
| | - Dominique Turck
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France
| | - Frédéric Gottrand
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France
| |
Collapse
|
6
|
Matthews CR, Hartman D, Farrell AG, Colgate CL, Gray BW, Zborek K, Herrmann JL. Impact of Home Monitoring Program and Early Gastrostomy Tube on Interstage Outcomes following Stage 1 Norwood Palliation. Pediatr Cardiol 2023; 44:124-131. [PMID: 35727331 DOI: 10.1007/s00246-022-02947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/31/2022] [Indexed: 01/24/2023]
Abstract
Nutritional management and home monitoring programs (HMPs) may be beneficial for improving interstage morbidity and mortality following stage I Norwood palliation (S1P) for hypoplastic left heart syndrome (HLHS). We recognized an increasing trend towards early feeding gastrostomy tube (GT) placement prior to discharge in our institution, and we aimed to investigate the effect of HMPs and GTs on interstage mortality and growth parameters. Single-institutional review at a tertiary referral center between 2008 and 2018. Individual patient charts were reviewed in the electronic medical record. Those listed for transplant or hybrid procedures were excluded. Baseline demographics, operative details, and interstage outcomes were analyzed in GT and non-GT patients (nGT). Our HMP was instituted in 2009, and patients were analyzed by era: I (early, 2008-2012), II (intermediate, 2013-2016), and III (recent, 2017-2018). 79 patients were included in the study: 29 nGTs and 50 GTs. GTs had higher number of preoperative risk factors more S1P complications, longer ventilation times, longer lengths of stay, and shorter times to readmission. There were no differences in interstage mortality or overall mortality between groups. There was one readmission for a GT-related issue with no periprocedural complications in the group. Weight gain doubled after GT placement in the interstage period while waiting periods for placement decreased across Eras. HMPs and early GTs, especially for patients with high-risk features, provide a dependable mode of nutritional support to optimize somatic growth following S1P.
Collapse
Affiliation(s)
- Caleb R Matthews
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Indiana School of Medicine, 545 Barnhill Drive, Emerson 215, Indianapolis, IN, 46202, USA
| | - Dana Hartman
- Section of Pediatric Cardiology, Department of Surgery, Indiana School of Medicine, Indianapolis, IN, USA
- Riley Children's Health at IU Health, Indianapolis, IN, USA
| | - Anne G Farrell
- Section of Pediatric Cardiology, Department of Surgery, Indiana School of Medicine, Indianapolis, IN, USA
- Riley Children's Health at IU Health, Indianapolis, IN, USA
| | - Cameron L Colgate
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brian W Gray
- Division of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children's Health at IU Health, Indianapolis, IN, USA
| | - Kirsten Zborek
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Indiana School of Medicine, 545 Barnhill Drive, Emerson 215, Indianapolis, IN, 46202, USA
- Riley Children's Health at IU Health, Indianapolis, IN, USA
| | - Jeremy L Herrmann
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Indiana School of Medicine, 545 Barnhill Drive, Emerson 215, Indianapolis, IN, 46202, USA.
- Riley Children's Health at IU Health, Indianapolis, IN, USA.
| |
Collapse
|
7
|
Fugazza A, Capogreco A, Cappello A, Nicoletti R, Da Rio L, Galtieri PA, Maselli R, Carrara S, Pellegatta G, Spadaccini M, Vespa E, Colombo M, Khalaf K, Repici A, Anderloni A. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14:250-266. [PMID: 35719902 PMCID: PMC9157691 DOI: 10.4253/wjge.v14.i5.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/03/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
Nutritional support is essential in patients who have a limited capability to maintain their body weight. Therefore, oral feeding is the main approach for such patients. When physiological nutrition is not possible, positioning of a nasogastric, nasojejunal tube, or other percutaneous devices may be feasible alternatives. Creating a percutaneous endoscopic gastrostomy (PEG) is a suitable option to be evaluated for patients that need nutritional support for more than 4 wk. Many diseases require nutritional support by PEG, with neurological, oncological, and catabolic diseases being the most common. PEG can be performed endoscopically by various techniques, radiologically or surgically, with different outcomes and related adverse events (AEs). Moreover, some patients that need a PEG placement are fragile and are unable to express their will or sign a written informed consent. These conditions highlight many ethical problems that become difficult to manage as treatment progresses. The aim of this manuscript is to review all current endoscopic techniques for percutaneous access, their indications, postprocedural follow-up, and AEs.
Collapse
Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Antonio Capogreco
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Annalisa Cappello
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna 40121, Italy
| | - Rosangela Nicoletti
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Leonardo Da Rio
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Piera Alessia Galtieri
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Roberta Maselli
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Gaia Pellegatta
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Edoardo Vespa
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Kareem Khalaf
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Milan, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| | - Andrea Anderloni
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
| |
Collapse
|
8
|
Naji H, Gheewale A, Safi E, Tuma F. Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study. BMC Surg 2022; 22:61. [PMID: 35193601 PMCID: PMC8862243 DOI: 10.1186/s12893-022-01515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background With gastrostomy becoming a common surgical procedure within the pediatric population surgeons continued to introduce modifications on the procedure to overcome some of the challenges and minimize complications. Modified U-stitches laparoscopic gastrostomy is gaining favor in some centers including the center of this study. Hence, this study was conducted to evaluate and compare its outcomes. Methods Eighty-nine gastrostomy procedures performed between 2013 and 2020 were reviewed to evaluate the surgical outcomes of a novel modified U-stitches laparoscopic gastrostomy (MLG) to the standard laparoscopic gastrostomy (LG) in children. The main outcome measured is the rate of postoperative complications encompassing dislodgement of gastrostomy button, leak around button, local infection, and development of granulation tissue post-surgery which is compared between the two population groups. Results The rate of leak around the button was found to be significantly less in the MLG (4%) compared to (15%) in the traditional LG approach with a p-value of 0.03. However, the overall complication rate for MGL is 63%; while it is 73% for LG. Conclusions The modified U-stitches laparoscopic gastrostomy has a lower rate of complications in comparison to the standard laparoscopic gastrostomy making it a preferred technique for gastrostomy placement in children.
Collapse
Affiliation(s)
- Hussein Naji
- Mediclinic Parkview Hospital, Dubai, UAE.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Aafia Gheewale
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.
| | - Ebtesam Safi
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Faiz Tuma
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| |
Collapse
|
9
|
McSweeney ME, Mitchell PD, Smithers CJ, Doherty A, Perkins J, Rosen R. A Retrospective Review of Primary Percutaneous Endoscopic Gastrostomy and Laparoscopic Gastrostomy Tube Placement. J Pediatr Gastroenterol Nutr 2021; 73:586-591. [PMID: 34259651 DOI: 10.1097/mpg.0000000000003236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The laparoscopic-assisted gastrostomy tube placement (LAP) has increasingly become the preferred method for placing gastrostomy tubes in infants and children. The goal of this retrospective review was to examine our institutional experiences with our transition from the percutaneous endoscopic gastrostomy (PEG) procedure to LAP technique. METHODS All patients undergoing primary PEG or LAP gastrostomy at Boston Children's Hospital between January 2010 and June 2015 were identified. The primary aim was to compare complication rates within the first 6 months after tube placement; differences in total hospital procedural costs, hospital resource utilization, and postoperative gastroesophageal reflux disease were examined. RESULTS Nine hundred and eighty-seven patients (442 PEG and 545 LAP gastrostomy tubes) were included. No differences in total complications within 6 months were seen. Patients undergoing PEG placement had more gastrostomy-related complications (PEG 30 [6.7%] vs LAP 13 [2.4%], P = 0.0007) and cellulitis (PEG 23 [5.1%] vs LAP 2 [0.4%], P = 0.03) within the first week of placement. Patients undergoing LAP procedures had more granulation tissue episodes (PEG 19 [4.4%] vs LAP 107 [19.8%], P = 0.005). No differences in emergency room visits, hospital readmissions, or postoperative gastroesophageal reflux disease were seen, although transition to a gastrojejunal tube was higher in patients undergoing LAP procedure (PEG 20 patients [4.6%] vs LAP 51 patients [9.5%], P = 0.0008). CONCLUSIONS Total complications were similar between patients undergoing PEG versus LAP gastrostomy tube placement. Patients with the PEG procedure had more complications within the first week of placement versus patients with the LAP procedure had more granulation skin complications.
Collapse
Affiliation(s)
| | - Paul D Mitchell
- Clinical Research Center, Boston Children's Hospital, Boston, MA
| | - C Jason Smithers
- Department of General Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Ashley Doherty
- Information Services, Boston Children's Hospital, Boston, MA
| | | | | |
Collapse
|
10
|
Marro M, De Smet S, Caldari D, Lambe C, Leclerc-Mercier S, Chiaverini C. Gastrostomy for infants with severe epidermolysis bullosa simplex in neonatal intensive care. Orphanet J Rare Dis 2021; 16:271. [PMID: 34116697 PMCID: PMC8196452 DOI: 10.1186/s13023-021-01896-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/29/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Severe epidermolysis bullosa simplex (EBS sev) is a rare genodermatosis characterized by congenital generalized blistering and mucosal involvement. Increased needs and decreased intake quickly lead to nutritional imbalance. Enteral nutrition support is proposed, but classical nasogastric tubes are not well tolerated in these patients and gastrostomy is preferred. OBJECTIVE AND METHODS To report the experience with EBS sev in neonatal units of French reference centers for gastrostomy. In this retrospective multicentric study, we included all patients with EBS sev who had gastrostomy placement before age 9 months during neonatal care hospitalization. RESULTS Nine infants (5 males/4 females) with severe skin and mucosal involvement were included. A gastrostomy was decided, at an early age (mean 3.7 months, range 1.4 to 8 months) in infants with mean weight 4426 g (range 3500 to 6000 g). Techniques used were endoscopy with the pull technique for 5 infants and surgery under general anesthesia for 4. Main complications were local but resolved after treatment. All infants gained weight after gastrostomy. The mean withdrawal time (n = 7) for the gastrostomy was 35.8 months (range 10.5 months to 6.5 years). Seven children had persistent oral disorders. CONCLUSIONS Gastrostomy in infants with EBS sev can be necessary in neonatal intensive care units. Both surgical and endoscopic pull techniques seem efficient, with good tolerance.
Collapse
Affiliation(s)
- M Marro
- Department of Dermatology, CRMRPM-Sud, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, 06200, Nice, France
| | - S De Smet
- Department of Neonatal Intensive Care, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - D Caldari
- Department of Pediatric Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - C Lambe
- Department of Pediatric Gastroenterology, Hôpital Universitaire Necker- Enfants Malades, Assistance Publique - Hôpitaux de Paris-Centre (AP-HP), Paris, France
| | - S Leclerc-Mercier
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Universitaire Necker- Enfants Malades, Assistance Publique - Hôpitaux de Paris-Centre (AP-HP), Paris, France
| | - C Chiaverini
- Department of Dermatology, CRMRPM-Sud, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, 06200, Nice, France.
| |
Collapse
|
11
|
Bolus versus continuous feeding regimens post gastrostomy tube placement in children. J Pediatr Surg 2021; 56:717-720. [PMID: 33023750 DOI: 10.1016/j.jpedsurg.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/30/2020] [Accepted: 09/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Owing to the frequency of gastrostomy tube placement in children and the numerous regimens used to start feeds after placement we attempted to see if it matters if the initial feeds after a gastrostomy tube placement are provided in a bolus or continuous manner. METHODS Using a prospective randomized trial, children were randomized to initial bolus or continuous chimney feeding after gastrostomy tube placement. Feeding tolerance and complications related to the gastrostomy tube were collected for 4 weeks after placement. RESULTS Demographics were similar in the two groups. Times to goal feeds were similar in both groups, but in the first two weeks more feeding modifications were required in the bolus group. Other than the rate of leakage during the second week after placement which occurred more in the bolus group, all other clinical outcomes were similar in the two groups. CONCLUSIONS Other than minor, clinically insignificant differences noted above, the method of initial feeding after a gastrostomy tube placement does not affect feeding tolerance or gastrostomy tube complication in the first month after placement. LEVEL OF EVIDENCE Therapeutic, level II.
Collapse
|
12
|
Characterization of Esophageal and Sphincter Reflexes across Maturation in Dysphagic Infants with Oral Feeding Success vs Infants requiring Gastrostomy. Dysphagia 2021; 37:148-157. [PMID: 33576892 DOI: 10.1007/s00455-021-10258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
To test the hypothesis that esophageal and sphincteric sensory-motor reflexes are distinct across maturation in infants with dysphagia receiving gastrostomy-tube (G-tube). This is a retrospective review of 29 dysphagic infants (N = 15 study requiring gastrostomy, N = 14 age matched control achieving oral feeds) that underwent longitudinal pharyngeal-esophageal manometry at 42.3 (37-50.2) weeks postmenstrual age (PMA) and 48.9 (43.3-57.9) weeks PMA. Graded stimuli (0.1-5 mL) of varying media (air, water, and apple juice) tested esophageal peristaltic reflex, upper esophageal sphincter contractile reflex (UESCR), and lower esophageal sphincter relaxation reflex (LESRR). Comparisons were performed between study and controls and across maturation (time-1 vs time-2). Data represented as mean ± SE or OR (95% CI). Across maturation (time-1 vs time-2): Study infants did not exhibit significant differences across in peristaltic, UES, or LES reflexes (all p > 0.05). In contrast, controls exhibited increased UES resting pressure (13 ± 3 vs 17 ± 3 mmHg, p = 0.001), LES resting pressure (22 ± 3 vs 25 ± 3 mmHg, p < 0.009), LES nadir pressure (0.5 ± 1 vs 4.3 ± 1 mmHg, p = 0.001), and esophago-deglutition responses [2.5 (1.23-4.88), p = 0.04], and decreased secondary peristalsis [0.44 (0.31-0.61), p = 0.001], UESCR [0.4 (0.25-0.65), p = 0.001], LESRR [0.4 (0.24-0.75), p = 0.01], and symptoms [0.6 (0.45-0.83), p = 0.005]. Among infants with dysphagia, esophageal provocation induced peristaltic reflex, UESCR, and LESRR advance with longitudinal maturation when infants are oral-fed successfully, but not in those who received gastrostomy. Underlying mechanisms may be related to esophageal sensitivity, afferent or efferent transmission, and coordination of upstream excitation and downstream inhibition, which can be potential therapeutic targets for improving feeding capabilities after gastrostomy placement in infants with dysphagia.
Collapse
|
13
|
Surgical Gastrostomy in Pediatric Patients Undergoing Cardiac Surgery. J Surg Res 2020; 259:516-522. [PMID: 33218701 DOI: 10.1016/j.jss.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Practices of performing gastrostomy tubes vary across institutions for patients undergoing cardiac surgery. We aim to elucidate the outcomes of gastrostomy and the duration of feeding assistance in these patients. MATERIALS AND METHODS Patients undergoing cardiac surgery (CS) at our institution from 2013 to 2017 were retrospectively reviewed using the Society of Thoracic Surgery database. A cohort of non-CS patients undergoing gastrostomy tube (g-tube) placement from 2013 to 2015 was used as control. Technical complications and postoperative feeding intolerance were analyzed. Duration of need for g-tube was also analyzed in patients undergoing CS. RESULTS The CS group had 144 patients, and the non-CS group had 677 patients. CS patients had a higher incidence of feeding intolerance (18.8% versus 5.6%, P < 0.001) and took longer to attain full feeds (median of 2 versus 1 d, P < 0.001), and this was confirmed on propensity matched analysis. In addition, technical g-tube complications were similar in the two groups. No mortality in CS was attributed to the g-tube. 58% of patients undergoing CS were able to wean from g-tube feeding by 6-12 mo after g-tube placement. CONCLUSIONS G-tube placement in patients undergoing CS by any technique is safe without increased complications. A significant portion of these patients was able to wean off supplemental enteral feeding assistance by a year after g-tube placement.
Collapse
|
14
|
Concomitant gastrostomy tube insertion during laparoscopic Nissen fundoplication for gastro-esophageal reflux disease: analysis of risk factors for fundoplication failure. Surg Endosc 2020; 35:4251-4258. [PMID: 32833100 DOI: 10.1007/s00464-020-07913-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laparoscopic Nissen fundoplication (LNF) and gastrostomy tube (GT) placement may be performed concomitantly in children with gastro-esophageal reflux disease (GERD) and failure to thrive. We aimed to evaluate the rate and risk factors for LNF failure in children undergoing concomitant LNF/GT. METHODS A retrospective multi-institutional cohort study was conducted, reviewing patients that underwent LNF (2005-2014). Data collected included patient demographics, comorbidities, and type of GT (laparoscopy- or endoscopy-assisted). The primary outcome measure was LNF failure. Data was compared using contingency tables or Mann-Whitney tests, when appropriate. An exploratory analysis by Kaplan-Meier survival and Cox proportional hazards analysis was performed to determine predictors of time to LNF failure after LNF/GT. RESULTS Of 189 children that underwent LNF, 99 (52%) had a concomitant GT (55% laparoscopy-, 45% endoscopy-assisted). LNF failed in 15% after LNF/GT and in 17% after LNF alone (p = 0.84), at a median age of 23 months (IQR 8-41). Using univariate analysis, we found that a younger age at the time of surgery (p = 0.05), prematurity (p = 0.0018), esophageal atresia (p = 0.01), and endoscopy-assisted GT (p = 0.02) were potential predictors of LNF failure after LNF/GT. After multivariate regression analysis, prematurity (p = 0.007) remained significantly associated with LNF failure after LNF/GT. No predictive factors for LNF failure after LNF alone were identified. CONCLUSIONS Concomitant GT insertion and LNF is a common practice, as half of the children that undergo LNF also received GT insertion. Children born preterm or with esophageal atresia comprise a fragile population at high-risk of LNF failure after LNF/GT. Prospective, multicentric studies are needed to evaluate the best GT technique to use in children undergoing LNF.
Collapse
|
15
|
McSweeney ME, Meleedy-Rey P, Kerr J, Chan Yuen J, Fournier G, Norris K, Larson K, Rosen R. A Quality Improvement Initiative to Reduce Gastrostomy Tube Placement in Aspirating Patients. Pediatrics 2020; 145:peds.2019-0325. [PMID: 31996405 PMCID: PMC6993527 DOI: 10.1542/peds.2019-0325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Oropharyngeal dysphagia and aspiration may occur in infants and children. Currently, there is wide practice variation regarding when to feed children orally or place more permanent gastrostomy tube placement. Through implementation of an evidence-based guideline (EBG), we aimed to standardize the approach to these patients and reduce the rates of gastrostomy tube placement. METHODS Between January 2014 and December 2018, we designed and implemented a quality improvement intervention creating an EBG to be used by gastroenterologists evaluating patients ≤2 years of age with respiratory symptoms who were found to aspirate on videofluoroscopic swallow study (VFSS). Our primary aim was to encourage oral feeding and decrease the use of gastrostomy tube placement by 10% within 1 year of EBG initiation; balancing measures included total hospital readmissions or emergency department (ED) visits within 6 months of the abnormal VFSS. RESULTS A total of 1668 patients (27.2%) were found to have aspiration or penetration noted on an initial VFSS during our initiative. Mean gastrostomy tube placement in these patients was 10.9% at the start of our EBG implementation and fell to 5.2% approximately 1 year after EBG initiation; this improvement was sustained throughout the next 3 years. Our balancing measures of ED visits and hospital readmissions also did not change during this time period. CONCLUSIONS Through implementation of this EBG, we reduced gastrostomy tube placement by 50% in patients presenting with oropharyngeal dysphagia and aspiration, without increasing subsequent hospital admissions or ED visits.
Collapse
Affiliation(s)
- Maireade E. McSweeney
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | | | | | | | - Gregory Fournier
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Kerri Norris
- Finance, Boston Children’s Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Rachel Rosen
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| |
Collapse
|
16
|
Mahmoud ME, Aldaraan KZ, Hassab MH, Aljabr SF. Schistosoma ova found in gastrostomy site granulation tissue. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
17
|
Association of gastrostomy placement on hospital readmission in premature infants. J Perinatol 2019; 39:1485-1491. [PMID: 31570794 PMCID: PMC7513590 DOI: 10.1038/s41372-019-0504-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We sought to determine the association of gastrostomy placement on post-NICU-discharge resource utilization in premature infants. STUDY DESIGN We performed a propensity-matched retrospective cohort study of NICU infants born under 32-week gestation in US Children's Hospitals. Multivariable logistic regression and propensity score-matching were used to determine the association of gastrostomy placement on 90-day hospital readmissions and emergency department visits adjusting for salient patient characteristics. RESULT A total of 12,621 premature infants were included of which 697 (5.5%) underwent gastrostomy placement. After propensity matching, infants who underwent gastrostomy placement have a higher rate of 90-day inpatient readmission (41.9 vs 26.3%, p < 0.001) and emergency department visit (27.1 vs 16%, p < 0.001). CONCLUSION Premature infants who undergo gastrostomy placement have increased the risk of inpatient readmission and emergency department visits after NICU discharge. Gastrostomy placement likely is both a driver and marker for increased resource utilization in premature infants post-NICU discharge.
Collapse
|
18
|
Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy-dependent Pediatric Patients. J Pediatr Gastroenterol Nutr 2018; 66:887-892. [PMID: 29261527 PMCID: PMC5963971 DOI: 10.1097/mpg.0000000000001866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Limited literature exists as to whether preoperative gastrostomy (GT) evaluation may predict which patients will go onto require gastrojejunostomy (GJ) tube feeding. The goal of this study was to compare the preoperative evaluations between patients maintained on GT feeds versus patients who required conversion to GJ feeds. METHODS We identified patients at Boston Children's Hospital who underwent GT tube placement and required GJ feeding between 2006 and 2012. GT patients were matched according to age, neurologic, and cardiac status with GJ-converted patients. Preoperative characteristics, rates of total hospitalizations, and respiratory-related admissions were reviewed. RESULTS A total of 79 GJ patients (median interquartile range (IQR): age 15 (4.3, 55.7) months; weight 8.8 (4.6, 14.5) kg) were matched with 79 GT patients (median (IQR): age 14.6 (4.7, 55.7) months; weight 8.5 (5, 13.6) kg). Median time from GT to GJ conversion was 8 (IQR 3, 16) months. Both groups had similar rates of successful preoperative nasogastric feeding trials (GT (84.5%) versus GJ (83.1%), P = 1.0), upper gastrointestinal series (GT (89.1%) versus GJ (93.2%), P = 0.73), abnormal videofluoroscopic swallow studies (GT (53.8%) versus GJ (62.2%), P = 0.4), and completion of gastric emptying studies (GT (10.1%) versus GJ (5.1%), P = 0.22). No differences were seen in preoperative hospitalization rates (P = 0.25), respiratory admissions (P = 0.36), although GJ patients had a mean reduction in the number of hospitalization of -1.5 ± 0.5 days, P < 0.001, after conversion. CONCLUSIONS No differences in preoperative patient characteristics or diagnostic evaluations were seen in GT fed versus GJ converted patients. GJ patients did experience an overall decrease in total admissions after GJ conversion.
Collapse
|
19
|
Macchini F, Zanini A, Farris G, Morandi A, Brisighelli G, Gentilino V, Fava G, Leva E. Infant Percutaneous Endoscopic Gastrostomy: Risks or Benefits? Clin Endosc 2018; 51:260-265. [PMID: 29310429 PMCID: PMC5997076 DOI: 10.5946/ce.2017.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIMS To present a single center's experience with percutaneous endoscopic gastrostomy (PEG) tube placement in infants. METHODS Clinical records of infants who underwent PEG tube placement between January 2010 and December 2015 were reviewed. All patients underwent an upper gastrointestinal contrast study and an abdominal ultrasonography before the procedure. PEGs were performed with a 6-mm endoscope using the standard pull-through technique. Data regarding gestational age, birth weight, age and weight, days to feeding start, days to full diet, and complications were reviewed. RESULTS Twenty-three patients were included. The most common indication was dysphagia related to hypoxic-ischemic encephalopathy. Median gestational age was 37 weeks (range, 24-41) and median birth weight was 2,605 grams (560-4,460). Patients underwent PEG procedures at a median age of 114 days (48-350); mean weight was 5.1 kg (3.2-8.8). In all patients but one, a 12-Fr tube was positioned. Median feeding start was 3 days (1-5) and on average full diet was achieved 5 days after the procedure (2-11). Six minor complications were recorded and effectively treated in the outpatient clinic; no major complications were recorded. CONCLUSIONS PEG is safe and feasible in infants when performed by highly experienced physicians.
Collapse
Affiliation(s)
- Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Zanini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giorgio Farris
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giulia Brisighelli
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Valerio Gentilino
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| |
Collapse
|
20
|
Why wait: early enteral feeding after pediatric gastrostomy tube placement. J Pediatr Surg 2018; 53:656-660. [PMID: 28689884 DOI: 10.1016/j.jpedsurg.2017.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/22/2017] [Accepted: 06/15/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Early initiation of feedings after gastrostomy tube (GT) placement may reduce associated hospital costs, but many surgeons fear complications could result from earlier feeds. We hypothesized that, irrespective of placement method, starting feedings within the first 6h following GT placement would not result in a greater number of post-operative complications. METHODS An IRB-approved retrospective review of all GTs placed between January 2012 and December 2014 at three academic institutions was undertaken. Data was stratified by placement method and whether the patient was initiated on feeds at less than 6h or after. Baseline demographics, operative variables, post-operative management and complications were analyzed. Descriptive statistics were used and P-values <0.05 were considered significant. RESULTS One thousand and forty-eight patients met inclusion criteria. GTs were inserted endoscopically (48.9%), laparoscopically (44.9%), or via an open approach (6.2%). Demographics were similar in early and late fed groups. When controlling for method of placement, those patients who were fed within the first 6h after gastrostomy placement had shorter lengths of stay compared to those fed greater than 6h after placement (P<0.05). Total post-operative outcomes were equivalent between feeding groups for all methods of placement (laparoscopic (P=0.87), PEG (P=0.94), open (P=0.81)). CONCLUSIONS Early initiation of feedings following GT placement was not associated with an increase in complications. Feeds initiated earlier may shorten hospital stays and decrease overall hospital costs. TYPE OF STUDY Multi-institutional retrospective. LEVEL OF EVIDENCE III.
Collapse
|
21
|
Kaya M, Sancar S, Ozcakir E. A New Method for Laparoscopic Stamm Gastrostomy. J Laparoendosc Adv Surg Tech A 2017; 28:111-115. [PMID: 29227195 DOI: 10.1089/lap.2017.0447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVE Many methods of laparoscopic gastrostomy have been described, but in the majority of these, purse-string sutures and fixation of the stomach to the abdominal wall are not performed simultaneously. In this study, we aim to present a new laparoscopic gastrostomy tube (GT) placement method developed in accordance with the classical Stamm method. MATERIALS AND METHODS Intracorporeal purse-string suture is placed at the anterior wall of the stomach where the GT is intended to be placed. While purse-string sutures are being placed, in each bite, the needle is passed through from a loop thread prepared by extracorporeal and the two threads are suspended outside. The stomach is punctured with the hook cautery, the GT is inserted, and both threads are knotted outside the abdomen. RESULTS We prospectively placed GT by using our method in 16 patients with an average age of 5 years and most of them with neurological developmental delay. Fundoplication was performed in most of the cases in the same session. No complications were encountered. CONCLUSIONS Our method is a feasible approach for GT placement by the purse-string suturing and the fixation of the stomach to the abdominal wall without extending the port incision.
Collapse
Affiliation(s)
- Mete Kaya
- Department of Pediatric Surgery, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa, Turkey
| | - Serpil Sancar
- Department of Pediatric Surgery, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa, Turkey
| | - Esra Ozcakir
- Department of Pediatric Surgery, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa, Turkey
| |
Collapse
|
22
|
Abstract
Parents often bring their children to the emergency department for adverse events with their child's gastrostomy tube or button. This review will discuss the possible complications and the methods to handle them.
Collapse
|
23
|
Pediatric gastrostomy tubes and techniques: making safer and cleaner choices. J Surg Res 2017; 220:88-93. [PMID: 29180216 DOI: 10.1016/j.jss.2017.06.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/21/2017] [Accepted: 06/28/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gastrostomy tube placement is a common procedure that can be accomplished with a variety of techniques, each with its attendant complications. In an effort to standardize practice at our institution, we retrospectively evaluated complications including early dislodgement requiring operative repair, leaks, and granulation tissue to determine the optimal technique. MATERIALS AND METHODS A retrospective cohort study (June 2008-July 2014) evaluating children (<18) receiving gastrostomy tubes was completed. We recorded demographic data, placement technique, and postoperative complications within 120 days. The seven techniques in use at our institution were categorized into three groups: standard pull-type techniques for percutaneous endoscopic gastrostomies (PEGs), "push" techniques using transabdominal sutures or T-fasteners for securement of the stomach, and "fascial" techniques using sutures directly from the stomach to the abdominal fascia at the stoma site. Descriptive statistics were analyzed using t test and Kruskal-Wallis tests as appropriate, and outcomes with P < 0.05 were considered significant. RESULTS Of the 450 patients, 255 (56.7%) were male. Median age and weight at the time of operation were 19.3 months (interquartile range, 6.5-89.6 months) and 9.0 kg (interquartile range, 5.7-17.1 kg) respectively. By technique, 245 patients underwent fascial placement (54.4%), 112 underwent push (24.9 %), and 93 underwent PEG (20.7%). Push and fascial techniques were less likely become dislodged than PEG, with odds ratios (ORs) of 0.14 (confidence interval CI 0.02-0.66) and 0.31 (CI 0.11-0.83), respectively. Fascial techniques had more granulation tissue than either push or PEG pull methods, OR 2.39 (CI 1.20-3.36), and more leakage, OR 2.22 (CI 1.19-4.15). CONCLUSIONS Dislodgement is most likely with PEG techniques. Granulation and leakage are most likely with fascial suture techniques. Push techniques are associated with the lowest complication rate.
Collapse
|
24
|
Miyata S, Dong F, Lebedevskiy O, Park H, Nguyen N. Comparison of operative outcomes between surgical gastrostomy and percutaneous endoscopic gastrostomy in infants. J Pediatr Surg 2017; 52:1416-1420. [PMID: 28139230 DOI: 10.1016/j.jpedsurg.2017.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Safety profile of different gastrostomy procedures in small children has not been well studied. This study was conducted to investigate whether complication and mortality rates differ between surgical gastrostomy (G-tube) and percutaneous endoscopic gastrostomy (PEG) in infants and neonates. METHODS In this retrospective study utilizing the Kids' Inpatient Database, all infants who underwent either G-tube or PEG as a sole procedure were identified. Variables included age, gender, race, presence of neurological impairment, prematurity, complex chronic condition, and severity of illness/risk of mortality subclasses. Postoperative complication, reoperation, and mortality rates were compared between G-tube and PEG. A subgroup of neonates was also analyzed. RESULTS A total of 1456 infants were identified (G-tube n=874, PEG n=582). In univariate analysis, the rates of adverse outcomes were not significantly different (G-tube vs PEG complication rate was 7.3% and 6.7%, p=0.65; mortality rate 1.3% and 0.7%, p=0.29, respectively). Adjusted odds ratios (ORs) for complication were 1.07 (G-tube vs PEG, 95% confidence interval [CI] 0.700-1.620) for overall infants and 1.19 (95% CI 0.601-2.350) for the neonatal subgroup. Similarly, adjusted ORs for mortality did not differ significantly both in infants (OR 1.749, 95% CI 0.532-5.755) and in the neonatal subgroup (OR 2.153, 95% CI 0.566-8.165). CONCLUSIONS When G-tube and PEG were performed as the only procedure throughout a hospitalization in infants and neonates, the two techniques had comparable risks of postoperative complications and mortalities. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
Collapse
Affiliation(s)
- Shin Miyata
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States; Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, United States.
| | - Fanglong Dong
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, United States.
| | - Olga Lebedevskiy
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States; Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, United States.
| | - Hanna Park
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, United States.
| | - Nam Nguyen
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, United States.
| |
Collapse
|
25
|
Affiliation(s)
- Christopher P Duggan
- From the Center for Advanced Intestinal Rehabilitation (C.P.D., T.J.), Division of Gastroenterology, Hepatology, and Nutrition (C.P.D.), and the Department of Surgery (T.J.), Boston Children's Hospital and Harvard Medical School, Boston
| | - Tom Jaksic
- From the Center for Advanced Intestinal Rehabilitation (C.P.D., T.J.), Division of Gastroenterology, Hepatology, and Nutrition (C.P.D.), and the Department of Surgery (T.J.), Boston Children's Hospital and Harvard Medical School, Boston
| |
Collapse
|
26
|
Kim J, Lee M, Kim SC, Joo CU, Kim SJ. Comparison of Percutaneous Endoscopic Gastrostomy and Surgical Gastrostomy in Severely Handicapped Children. Pediatr Gastroenterol Hepatol Nutr 2017; 20:27-33. [PMID: 28401053 PMCID: PMC5385304 DOI: 10.5223/pghn.2017.20.1.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/12/2016] [Accepted: 10/27/2016] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Gastrostomy is commonly used procedures to provide enteral nutrition support for severely handicapped patients. This study aimed to identify and compare outcomes and complications associated with percutaneous endoscopic gastrostomy (PEG) and surgical gastrostomy (SG). METHODS A retrospective chart review of 51 patients who received gastrostomy in a single tertiary hospital from January 2000 to May 2016 was performed. We analyzed the patients and the complications caused by the procedures. RESULTS Among the 51 patients, 26 had PEG and 25 had SG. Four cases in the SG group had fundoplication for gastroesophageal reflux disease. PEG and SG groups were followed up for an average of 29 months and 44 months. Major complications occurred in 19.2% of patients in the PEG group and 20.0% in the SG group, but significant differences between the groups were not observed. Minor complications occurred in 15.4% of patients in the PEG group and 52.0% in the SG group. Minor complications were significantly lower in the PEG group than in the SG group (p=0.006). The average use of antibiotics in the PEG and SG groups was 6.2 days and 15.7 days (p=0.002). Thirteen patients died of underlying disease but not related to gastrostomy, and only one patient died due to complications associated with general anesthesia. CONCLUSION The duration of antibiotics use and incidence of minor complications were significantly lower in the PEG group than those in the SG group. Early PEG could be recommended for nutritional supports.
Collapse
Affiliation(s)
- June Kim
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Min Lee
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Chan Uhng Joo
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| |
Collapse
|