Laparoscopic Gastrostomy Placement in Children Has Few Major, but Many Minor Early Complications

Banaja

Asian J Endoscop Surgery

et al. 2022

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a common procedure in children. The outcomes of PEG could be affected by the associated disease. We aimed to evaluate the outcomes and safety of PEG tube placement in a tertiary care center with special attention to patients with cardiac disease, ventriculoperitoneal (VP) shunt, or peritoneal dialysis (PD) catheter. Methods: This retrospective study included 113 pediatric patients who had PEG tube insertion from 2011 to 2021. Eighteen patients (15.93%) had cardiac disease, five patients (4.42%) had PD catheters, and three patients (2.65%) had VP shunt. Results: The median age was 3 years (interquartile range: 1-6), and females represented 55% of our patients. The weight ranged from 2.57 to 60 kg, and the most common indication for insertion was neurological disease (n = 56; 49.56%). The median operative time was 30 (20-45) minutes. Pneumonia and vomiting were the most frequent complications (n = 20, 17.7%). Thirty-day mortality occurred in four patients (3.54%) and 1-year mortality in 10 patients (8.85%). Nine patients (7.96%) required fundoplication, and four patients (3.53%) had tube removal and reinsertion. There was no association between weight and postoperative complications (odds ratio: 0.97; P = .48). There were no differences in postoperative complications among patients with cardiac diseases, PD catheters, and VP shunts. No complications were reported in patients with VP shunt. One patient with cardiac disease and one patient with PD catheter required fundoplication. Removal and reinsertion were needed in one patient with a PD catheter. Conclusion:PEG is feasible in low-weight infants with a low complication rate. The complication rate is low in patients with VP shunt, PD catheter, and cardiac patients.

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic gastrostomy is an alternative to PEG insertion with a lower incidence of major complications. 22 This technique is important in low-weight patients and if a concomitant fundoplication is required. 23 Persistent gastrocutaneous fistula complicates about 30% of gastrostomies in children.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy in children: A tertiary center experience

Banaja

Asian J Endoscop Surgery

et al. 2022

Pediatrics International

“…Laparoscopic gastrostomy (LG) is an alternative gastrostomy technique considered to be safe and effective in previous pediatric reports, with a few procedure-related major complications. 14,15 LG can be preferable over PEG in small infants especially if a concomitant fundoplication is needed. 15 Mortalities occurred due to associated morbidities at a high rate in our series.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy in small infants unable to swallow safely

Durakbaşa

Ozumut

Orhon

et al. 2020

Background: Data about percutaneous endoscopic gastrostomy (PEG) insertions in small infants are limited, and most studies include older children. We aimed to evaluate the safety of PEG placement in infants weighing ≤5 kg together with their follow-up results. Methods: A retrospective evaluation was made of records between January 2005 and December 2019. Results: A total of 43 infants were ≤5 kg at the time of PEG insertion. The mean age was 5 AE 3 (19 days-16 months) months and the mean weight was 4.3 AE 0.6 (2.7-5.0) kg. The primary diagnoses were neurological disorders in 25, metabolic disorders in nine, cleft palates in four, muscular disorders in four, and a cardiac disorder in one. All procedures were completed successfully. A self-resolving pneumoperitoneum developed in one (2.3%). The tube was extruded in six (14%) patients postoperatively which required suture-approximation of the skin and subcuticular tissues. The tube was removed in four (9%) patients with achievement of oral feeds on the long-term. Eighteen (42%) died of primary diseases. The tubes were in situ for a median of 12.4 (17 days-73 months) months in these patients. A total of 20 (46.5%) patients are currently being followed up and their tubes are in situ for a median of 50.3 (4.7 month-9.8 years) months. Conclusions: Percutaneous endoscopic gastrostomy placement is safe in small infants with associated morbidities. Complications related to the procedure are within acceptable limits. The accidental extrusion of the tube was a special consideration in this patient group. The overall mortality was high because of underlying primary diseases.

“…It follows then that both prevention and effective countermeasures for complications offer to relieve pain and disutility for patients, while also reducing costs and sparing tight resources. Although many papers have appeared in the literature reviewing tube-related troubles, [1][2][3] none seem to offer frontline clinicians a practical playbook for managing these problems. Instead, mismanagement generated by widespread misunderstandings of tubes and tube complications remains endemic.…”

Section: Pitfall: Know the Termsmentioning

confidence: 99%

Troubleshooting the pediatric gastrostomy

Blinman

Hiller

2023

Nut in Clin Prac

Gastrostomy tubes benefit patients but also introduce hazards and costs. Most of these costs tend to be administratively invisible, but clinically expensive. Nurses, residents, emergency physicians, surgeons, and others routinely manage complaints about gastrostomy tubes or sites, and the time and effort costs are enormous. Despite widespread use of gastrostomy tubes and the large “cost of ownership,” scant instruction guides practitioners on troubleshooting the panoply of tube‐related problems. Instead, clinical folk‐wisdom leaves staff disarmed, resorting to lore or maladaptive work‐arounds that are futile or even harmful. But tubes and gastrostomies fail in predictable ways. This guide reviews commonly used gastrostomy tubes and how they are placed. Routine care of these tubes both in the immediate postoperative period and long‐term is detailed. Then, specific gastrostomy tube complications and their principle‐based countermeasures are described, organized by presenting complaint. Throughout, specific clinical pitfalls are called out along with their remedies. The aim is to demystify these devices and dispel myths that lead to error.