Pediatric gastrostomy tubes and techniques: making safer and cleaner choices

Sutherland, Cabrini; Carr, Benjamin; Biddle, Kassia; Jarboe, Marcus D.; Gadepalli, Samir K.

doi:10.1016/j.jss.2017.06.075

Cited by 27 publications

(20 citation statements)

References 16 publications

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“…Previous studies have compared the various gastrostomy techniques, including open gastrostomy and laparoscopic gastrostomy, [8][9][10][11][12] but relatively few studies have been conducted to compare the various suture techniques used to secure the gastric wall to the anterior abdominal wall. Therefore, it is unclear which suture technique predisposes pediatric patients to the fewest postoperative complications after a laparoscopic gastrostomy.…”

Section: Introductionmentioning

confidence: 99%

Outcomes After Laparoscopic Gastrostomy Suture Techniques in Children

Mason

Skarda

Bucher

2018

Journal of Surgical Research

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Background: There are various suture techniques used during laparoscopic gastrostomy to secure the stomach to the anterior abdominal wall. However, it remains unclear whether temporary fixation or subcutaneous absorbable sutures predispose pediatric patients to fewer postoperative complications. Our goal was to determine if a particular suture technique resulted in an increased risk for the development of postoperative complications.Materials and methods: A retrospective cohort analysis was performed for patients less than 18 y of age who underwent laparoscopic gastrostomy at a tertiary Children's Hospital between 2012 and 2016. Children were grouped according to suture techniques for laparoscopic gastrostomy placement: temporary sutures or subcutaneous absorbable sutures.Postoperative outcomes at 30 d were defined as major complications (tube dislodgement, unplanned reoperation, readmission) and minor complications (stitch abscess, surgical site infection, emergency department visit). The chi squared test was used to determine if an association existed between the suture techniques and 30 d postoperative complications.Results: We identified 682 pediatric patients who underwent laparoscopic gastrostomy. There were 301 (44%) patients with subcutaneous sutures placed and 381 (56%) with temporary sutures placed. The overall rate of major and minor complications was 8.3% and 22%, respectively. We observed a significant difference in the occurrence of major postoperative complications between the subcutaneous and temporary suture techniques (11% versus 6.3%, P ¼ 0.029). There was no significant difference in the development of minor complications between subcutaneous and temporary suture techniques.Conclusions: Children who receive subcutaneous sutures during laparoscopic gastrostomy are at an increased risk for developing a major postoperative complication.

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Section: Introductionmentioning

confidence: 99%

Outcomes After Laparoscopic Gastrostomy Suture Techniques in Children

Mason

Skarda

Bucher

2018

Journal of Surgical Research

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“…The KID captures mortality but few other outcomes, thereby limiting this study's evaluation of potentially differential outcomes between PEG and SG. Outcomes can also vary depending on the specific technical aspects within each approach (PEG and SG), such as using fascial sutures, fluoroscopy, or transabdominal sutures [18]. Those technical details could not be ascertained given the use of ICD-9 codes in this study.…”

Section: Discussionmentioning

confidence: 99%

Variability in the Method of Gastrostomy Placement in Children

et al. 2020

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Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years old undergoing percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) (including open or laparoscopic) from 1997 to 2012 were identified using the Kids’ Inpatient Database. Method of gastrostomy placement was evaluated using a multivariable mixed-effects logistic regression model with a random intercept term and a patient-age random-effect term. A total of 67,811 gastrostomy placements were performed during the study period. PEG was used in 36.6% of entries overall and was generally consistent over time. PEG placement was less commonly performed in infants (adjusted odds ratio [aOR] 0.30, 95%CI 0.26–0.33), children at urban hospitals (aOR: 0.38, 95%CI 0.18–0.82), and children cared for at children’s hospitals (aOR 0.57, 95%CI 0.48–0.69) and was more commonly performed in children with private insurance (aOR 1.17, 95%CI 1.09–1.25). Dramatic variability in PEG use was identified between centers, ranging from 0% to 100%. The random intercept and slope terms significantly improved the model, confirming significant center-level variability and increased variability among patients <1 year old. These findings emphasize the need to further evaluate the safest method of gastrostomy placement in children, in particular among the youngest patients in whom practice varies the most.

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“…Gastrostomy placement is a common general pediatric surgical procedure that is usually straightforward and simple. However, major and minor complications can lead to a significant burden for the patients and their families, in the form of multiple clinic visits, readmissions, and even repeated surgical procedures [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Button Gastrostomy Tubes for Pediatric Patients: A Tertiary Care Center Experience

Haider

Isa

Awadhi

et al. 2020

International Journal of Pediatrics

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Background and Objective. Gastrostomy tube insertion is one of the most common procedures performed as a radical choice to overcome feeding difficulty in children. This study is aimed at describing the replacement of a button tube instead of the long tube for feeding infants and children requiring gastrostomies in a tertiary care hospital. Design and Setting. This retrospective cross-sectional descriptive study was conducted between January 2009 and August 2019 at Salmaniya Medical Complex which is a tertiary health care institute in the Kingdom of Bahrain. Subjects and Methods. Both charts and electronic health records of pediatric patients between the ages of 0 and 14 years were reviewed. Data were collected including age, sex, nationality, diagnosis, surgical information (procedure center and procedure performed), complications, and follow-up. Results. Out of 34 patients who underwent gastrostomy tube insertion, 30 patients had their long tube replaced by a button gastrostomy. Majority were males (N=18, 60%). Prolonged nasogastric tube feeding was the main indication of referral (N=17, 56%) followed by feed intolerance (N=6, 17%) and gastroesophageal reflux disease (N=5, 16%). The main underlying diseases at referral were neurological impairment (N=19, 63%) and metabolic disorders (N=4, 13%). There was no significant difference between patients with neurological disorders and other diseases in terms of gender, nationality, or age. Laparotomy with gastrostomy is the main approach used (N=18, 60%). No reported complications of button tubes in 50% of the patients (N=15). Conclusions. Prolonged nasogastric tube feeding is the main indication of referral for gastrostomy tube insertion. Neurological disorders are the main diagnosis for the cases operated upon. Laparotomy with gastrostomy is the procedure of choice at our center. Majority of patients had no reported complications of button tube replacement. These children are likely to benefit from the button tube with fewer complications.

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Pediatric gastrostomy tubes and techniques: making safer and cleaner choices

Cited by 27 publications

References 16 publications

Outcomes After Laparoscopic Gastrostomy Suture Techniques in Children

Outcomes After Laparoscopic Gastrostomy Suture Techniques in Children

Variability in the Method of Gastrostomy Placement in Children

Button Gastrostomy Tubes for Pediatric Patients: A Tertiary Care Center Experience

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