Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Reduces Major Complications in High-Risk Pediatric Patients

Balogh, Brigitta; Szűcs, Dániel; Gavallér, Gabriella; Rieth, Anna; Kovács, Tamás

doi:10.5223/pghn.2021.24.3.273

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…This has been reported in previous studies, although some authors argue for different preferable operative techniques. 4,5,[16][17][18] The most common reason to receive a gastrostomy in our study was an underlying neurological disease. Comparing with mentioned group of patients, we could see that the oncologic patients reported lower incidence of granulomas, more postoperative pain and a higher rate of infections.…”

Section: Discussionmentioning

confidence: 77%

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Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

et al. 2023

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Aim To evaluate if the incidence of postoperative complications after gastrostomy placement is correlated to perioperative parameters or patient characteristics. Methods In this prospective observational study, children <18 years of age planned to receive a gastrostomy at partaking clinics between 2014 and 2019 were invited. Pre‐, peri‐ and postoperative variables were collected and followed up 3 months postoperatively. Results Five hundred and eighty‐two patients were included (median age: 26 months, median weight: 10.8 kg), mainly laparoscopic (52.0%) and push‐PEG (30.2%) technique used. The incidence of complications was lower in the group of patients receiving a gastrostomy tube that was 2 mm longer than the gastrostomy canal (p < 0.001–0.025), and a thickness of 12 Fr (p < 0.001–0.009). These findings were confirmed by multivariate analysis also including operative technique, age and weight. Patients with oncological disease had significantly higher incidence of pain and infection but the lowest incidence of granulomas (p < 0.001–0.01). Conclusion This study indicates that a 12 Fr gastrostomy tube that is 2 mm longer than the gastrostomy canal is correlated with the lowest incidence of postoperative complications the first 3 months after surgery. Oncological patients had the lowest incidence of granulomas which probably is related to chemotherapy.

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Section: Discussionmentioning

confidence: 77%

“…Our study supports the idea that the technique should be chosen according to the surgeons' experience and suitability for the patient. This has been reported in previous studies, although some authors argue for different preferable operative techniques 4,5,16–18 …”

Section: Discussionmentioning

confidence: 99%

Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

et al. 2023

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“…Such complications encompassed severe outcomes like death, peritonitis, visceral injury, ileus, and the need for repeat surgery (18). The most minor complications after PEG include wound discharge, leakage, and hyperemia (5,19,20). It is our belief that the variation in reported rates of minor complications can be attributed to variations in data collection and reporting practices across different centers.…”

Section: Discussionmentioning

confidence: 99%

Impact of Scoliosis Severity on Gastrostomy-Related Complications in Children

Toker Kurtmen,

Nalli,

Oztan

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: This study aimed to determine the relationship between scoliosis and risk of developing complications in patients who underwent gastrostomy. Methods: Patients who underwent percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) between 2012 and 2022 were included. Leakage, discharge, granuloma, and hyperemia were considered minor complications, while visceral injury, ileus, and re-do surgery were considered major complications. The degree of scoliosis was calculated using the Cobb angle. The SG and PEG groups were compared by evaluating the complications and their correlation with scoliosis. Results: A total of 104 patients with a mean age of 5.0 ± 5.3 were included; 58% of patients were treated with SG. Patients in the SG group were younger (P < 0.001). Minor complications were significantly more common in the PEG group (P = 0.018). There was no difference between the groups in terms of major complications (P = 1.000). Scoliosis was observed in 32.7% of the patients (n = 34). In the SG group, no correlation was found between the Cobb angle and the frequency of minor (P = 0.173) or major complications (P = 0.305). There was no significant difference between the Cobb angles of patients with and without minor complications in the PEG group (P = 0.478); the Cobb angles of patients with major complications (75°) were significantly higher than those without (36°) (P = 0.030). Conclusion: Gastrostomy is important for weight gain and nutritional needs of children. This study showed that the risk of complications in SGs did not correlate with the degree of scoliosis and that the risk of major complications in PEGs increased in patients with a high degree of scoliosis.

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“…However, fundoplication or gastrostomy using laparoscopy cannot shorten the procedure time or eliminate the need for general anesthesia, although a recent study reported that laparoscopic PEG may be safer than conventional PEG in high-risk pediatric patients with severe thoracoabdominal deformity, previous abdominal surgery, ventriculoperitoneal shunt, and abdominal tumors. 14 15 In addition, the difference in the procedures time depends more on the ability of the operator than on the procedure method. In this study, among the cases in which gastrostomy was performed again, there was a case in which the stormy site was placed too close to the pylorus, causing ballooning to interfere with gastric emptying.…”

Section: Discussionmentioning

confidence: 99%

Nationwide Survey for Pediatric Gastrostomy Tube Placement in Korea

et al. 2022

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Background Various methods have been implemented for pediatric gastrostomy tube placement. We aimed to investigate the performance status of pediatric gastrostomy in South Korea and to present indications and appropriate methods for domestic situations. Methods A survey was conducted among pediatric endoscopists who performed upper gastrointestinal endoscopy in Korea. The questionnaire consisted of 16 questions on gastrostomy performance status. Results Among the 48 institutions where the survey was applied, 36 (75%) responded. Of the 36 institutions, gastrostomy was performed in 31 (86.1%). The departments in which gastrostomy was performed were pediatrics at 26 institutions (81.3%), surgery at 24 institutions (75.0%), internal medicine at 9 institutions (28.1%), and radiology at 7 institutions (21.9%). There were 18 institutions (66.7%) using the pull method for percutaneous endoscopic gastrostomy (PEG) and nine institutions (33.3%) using the push method. When performing gastrostomies, fundoplication procedures were performed in 19 institutions (61.3%), if deemed necessary. However, 12 institutions (38.7%) answered that gastrostomy was always implemented alone. Complications after gastrostomy included buried bumper syndrome, wound infection, leakage, tube migration, and incorrect opening site in the stomach, but the number of cases with complications was very small. Conclusion In Korea, a pediatric gastrostomy is implemented in various ways depending on the institution. Clinicians are concerned about choosing the most effective methods with fewer complications after the procedure. In our study, we reported only a few complications. Korea has good accessibility for pediatric gastrointestinal endoscopy, and this survey showed that it is a safe procedure that can be considered initially in pediatric gastrostomy. This study is expected to help to create optimal pediatric PEG guidelines in Korea.

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Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Reduces Major Complications in High-Risk Pediatric Patients

Cited by 4 publications

References 7 publications

Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

Complication rate after gastrostomy placement in children can be reduced by simple surgical steps

Impact of Scoliosis Severity on Gastrostomy-Related Complications in Children

Nationwide Survey for Pediatric Gastrostomy Tube Placement in Korea

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