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Reiter AJ, Longi F, Thomae BL, Carter MM, Harris CJ, Jacobs C, Sullivan GA, Lautz TB, Raval MV. Pediatric Gastrostomy Tube Placement: Avoid the Incision to Avoid the Complications. J Laparoendosc Adv Surg Tech A 2025; 35:419-424. [PMID: 40097236 DOI: 10.1089/lap.2024.0036] [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] [Indexed: 03/19/2025] Open
Abstract
Background: Tremendous practice variation exists for placing gastrostomy tubes. The objective of this study was to determine if the operative approach is associated with 30-day complication rates. Methods: This single-center retrospective cohort study identified pediatric patients who underwent gastrostomy tube placement from June 2019 to April 2022. Gastrostomy approaches included laparoscopic, laparoscopic-assisted (incision at gastrostomy site), modified open (incision at gastrostomy site), and percutaneous endoscopic gastrostomy (PEG). Multivariable logistic regression models were performed to evaluate the association of 30-day complications and operative approach after controlling for prematurity and weight. Results: Among 521 gastrostomy patients, the median age was 10 months (interquartile range: 4-33 months), and 181 (34.9%) had a history of prematurity. Weight categories included 217 (41.6%) underweight, 272 (52.2%) normal weight, and 32 (6.1%) overweight. Patients underwent laparoscopic (n = 386, 74.1%), laparoscopic-assisted (n = 73, 14.0%), modified open (n = 33, 6.3%), and PEG (n = 27, 5.2%). Complications included reoperation (n = 17, 3.3%), readmission (n = 12, 2.3%), wound infection (n = 30, 5.8%), wound breakdown (n = 21, 4.0%), tube dislodgement (n = 23, 4.4%), granulation tissue (n = 107, 20.5%), and leakage (n = 33, 6.3%). Following adjustment, laparoscopic-assisted gastrostomy was associated with higher odds of any complication. Laparoscopic-assisted and modified open were associated with higher odds of wound breakdown. Laparoscopic-assisted and modified open were associated with higher odds of leakage. The operative approach was not associated with reoperation, readmission, wound infection, or tube dislodgement. Conclusions: Techniques for gastrostomy placement, which include an incision around the tube, were associated with higher rates of complications. To improve complication profiles for patients, surgeons should consider laparoscopic or percutaneous endoscopic gastrostomies.
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Affiliation(s)
- Audra J Reiter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Faraz Longi
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Benjamin L Thomae
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michela M Carter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Courtney J Harris
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Caitlin Jacobs
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Bahdi F, Labora A, Shah S, Farooq M, Wangrattanapranee P, Donahue T, Issa D. From Scalpel to Scope: How Surgical Techniques Made Way for State-of-The-Art Endoscopic Procedures. GASTRO HEP ADVANCES 2023; 3:370-384. [PMID: 39131137 PMCID: PMC11307641 DOI: 10.1016/j.gastha.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/30/2023] [Indexed: 08/13/2024]
Abstract
The continuous evolution of endoscopic tools over the years has paved the way for minimally invasive alternatives to surgical procedures for multiple gastrointestinal conditions. While few endoscopic techniques have supplanted their surgical counterparts like percutaneous gastrostomy tubes, many have emerged as noninferior, less morbid alternatives for such diverse conditions as achalasia (peroral endoscopic myotomy), obesity (endoscopic sleeve gastroplasty), drainage of pancreatic walled off necrosis (EUS-guided cystogastrostomy), and gastric outlet obstruction (EUS-guided gastrojejunostomy). These techniques were based on surgical concepts and would not have been feasible without collaboration between surgeons and endoscopists. Such collaboration is exemplified by the antireflux fundoplication, which features combined hiatal hernia repair with transoral and incisionless fundoplication. The burgeoning armamentarium of endoscopic alternatives to traditional surgical procedures requires a multidisciplinary discussion and individually tailored treatment plans that consider patient preferences as well as the relative risks and benefits of surgical and endoscopic approaches. As technological advances give rise to ever more innovative endoscopic techniques, studies to evaluate clinical outcomes and define their role in treatment algorithms will be required.
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Affiliation(s)
- Firas Bahdi
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Amanda Labora
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sagar Shah
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Maryam Farooq
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Peerapol Wangrattanapranee
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Timothy Donahue
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Danny Issa
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Berman L, Baird R, Sant'Anna A, Rosen R, Petrini M, Cellucci M, Fuchs L, Costa J, Lester J, Stevens J, Morrow M, Jaszczyszyn D, Amaral J, Goldin A. Gastrostomy Tube Use in Pediatrics: A Systematic Review. Pediatrics 2022; 149:186999. [PMID: 35514122 DOI: 10.1542/peds.2021-055213] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Despite frequency of gastrostomy placement procedures in children, there remains considerable variability in preoperative work-up and procedural technique of gastrostomy placement and a paucity of literature regarding patient-centric outcomes. OBJECTIVES This review summarizes existing literature and provides consensus-driven guidelines for patients throughout the enteral access decision-making process. DATA SOURCES PubMed, Google Scholar, Medline, and Scopus. STUDY SELECTION Included studies were identified through a combination of the search terms "gastrostomy," "g-tube," and "tube feeding" in children. DATA EXTRACTION Relevant data, level of evidence, and risk of bias were extracted from included articles to guide formulation of consensus summaries of the evidence. Meta-analysis was conducted when data afforded a quantitative analysis. EVIDENCE REVIEW Four themes were explored: preoperative nasogastric feeding tube trials, decision-making surrounding enteral access, the role of preoperative imaging, and gastrostomy insertion techniques. Guidelines were generated after evidence review with multidisciplinary stakeholder involvement adhering to GRADE methodology. RESULTS Nearly 900 publications were reviewed, with 58 influencing final recommendations. In total, 17 recommendations are provided, including: (1) tTrial of home nasogastric feeding is safe and should be strongly considered before gastrostomy placement, especially for patients who are likely to learn to eat by mouth; (2) rRoutine contrast studies are not indicated before gastrostomy placement; and (3) lLaparoscopic placement is associated with the best safety profile. LIMITATIONS Recommendations were generated almost exclusively from observational studies and expert opinion, with few studies describing direct comparisons between GT placement and prolonged nasogastric feeding tube trial. CONCLUSIONS Additional patient- and family-centric evidence is needed to understand critical aspects of decision-making surrounding surgically placed enteral access devices for children.
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Affiliation(s)
- Loren Berman
- Departments of Surgery.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Baird
- Department of Pediatric General and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana Sant'Anna
- Department of Pediatrics, Division of Gastroenterology and Nutrition, McGill University Health Center, Montreal, Quebec, Canada
| | - Rachel Rosen
- Aerodigestive Center, Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Maria Petrini
- Pediatrics.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Cellucci
- Pediatrics.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lynn Fuchs
- Neonatology.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joanna Costa
- Neonatology.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lester
- Nutrition.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jenny Stevens
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Michele Morrow
- Therapy Services, Nemours Children's Health, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Joao Amaral
- Department of Diagnostic Imaging, Division of Interventional Radiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Goldin
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
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Sykes AG, Prieto JM, Thangarajah H, Keller BA, Kling KM, Ignacio RC, Lazar DA. Modified laparoscopic gastrostomy tube placement in children: Does subcutaneous suture type matter? J Pediatr Surg 2022; 57:1145-1148. [PMID: 35304024 DOI: 10.1016/j.jpedsurg.2022.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laparoscopic gastrostomy tube (GT) placement carries the risk of early tube dislodgement and is often modified with absorbable subcutaneously-tunneled transabdominal tacking sutures that can aid in tube replacement. However, these buried sutures may increase the risk of surgical site infection (SSI). This study sought to evaluate SSI rates associated with different types of transabdominal tacking sutures used in modified laparoscopic GT placement. METHODS A single-institution, retrospective review was performed of all patients ≤18 years-old undergoing modified laparoscopic GT placement between September 2016 and March 2020. Patients were stratified into three groups by suture type used, and the primary outcome was SSI within six weeks of surgery. Demographic and perioperative data were analyzed by chi-square or Fisher's exact test. RESULTS A total of 113 modified laparoscopic GT placements were performed at a median age of 9 months (interquartile range 3 months to 3 years). Prophylactic antibiotic use was similar between groups. Eleven patients (10%) developed an SSI, and all were treated with antibiotics alone. No SSIs were observed with the use of poliglecaprone suture (n = 46), and higher SSI rates were observed with use of polyglactin (n = 17) and polydioxanone (n = 51) suture (18% polyglactin vs. 16% polydioxanone vs. 0% poliglecaprone, p<0.05). No differences were observed in rates of early postoperative dislodgement, leakage, or granulation tissue. CONCLUSION Absorbable braided and long-lasting monofilament transabdominal tacking sutures may increase risk of SSI following modified laparoscopic gastrostomy tube placement. In this cohort, the use of poliglecaprone (Monocryl) suture was associated with no SSIs and similar rates of postoperative dislodgement, leakage, and granulation tissue. LEVEL OF EVIDENCE Treatment Study, Level III.
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Affiliation(s)
- Alicia G Sykes
- Division of Pediatric Surgery, Rady Children's Hospital, 3030 Children's Way #107, San Diego, CA 92123, United States of America
| | - James M Prieto
- Division of Pediatric Surgery, Rady Children's Hospital, 3030 Children's Way #107, San Diego, CA 92123, United States of America
| | - Hariharan Thangarajah
- Division of Pediatric Surgery, Rady Children's Hospital, 3030 Children's Way #107, San Diego, CA 92123, United States of America; Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9300 Campus Point Drive, MC7400, La Jolla, CA 92037-7400, United States of America
| | - Benjamin A Keller
- Division of Pediatric Surgery, Rady Children's Hospital, 3030 Children's Way #107, San Diego, CA 92123, United States of America; Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9300 Campus Point Drive, MC7400, La Jolla, CA 92037-7400, United States of America
| | - Karen M Kling
- Division of Pediatric Surgery, Rady Children's Hospital, 3030 Children's Way #107, San Diego, CA 92123, United States of America; Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9300 Campus Point Drive, MC7400, La Jolla, CA 92037-7400, United States of America
| | - Romeo C Ignacio
- Division of Pediatric Surgery, Rady Children's Hospital, 3030 Children's Way #107, San Diego, CA 92123, United States of America; Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9300 Campus Point Drive, MC7400, La Jolla, CA 92037-7400, United States of America
| | - David A Lazar
- Division of Pediatric Surgery, Rady Children's Hospital, 3030 Children's Way #107, San Diego, CA 92123, United States of America; Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9300 Campus Point Drive, MC7400, La Jolla, CA 92037-7400, United States of America.
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Osei H, Munoz-Abraham AS, Martino A, Chatoorgoon K, Greenspon J, Fitzpatrick C, Villalona GA. To Button or Not to Button? Primary Gastrostomy Tubes Offer No Significant Advantage Over Buttons. Pediatr Gastroenterol Hepatol Nutr 2022; 25:211-217. [PMID: 35611372 PMCID: PMC9110846 DOI: 10.5223/pghn.2022.25.3.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Outcomes between primary gastrostomy tubes and buttons (G-tube and G-button) have not been established in pediatric patients. We hypothesized that primary G-tube have decreased complications when compared to G-button. METHODS A retrospective review of surgically placed gastrostomy devices from 2010 to 2017 was performed. Data collected included demographics, outcomes and 90-day complications. We divided the patients into primary G-tube and primary G-button. RESULTS Of 265 patients, 142 (53.6%) were male. Median age and weight at the time of surgery were 7 months (interquartile range [IQR], 2-44 months) and 6.70 kg (IQR, 3.98-14.15 kg), respectively. Among the groups, G-tube had 80 patients (30.2%) while G-button 185 patients (69.8%). There were 153 patients with at least one overall complication within 90 days postoperative. There was no significant difference in overall complications between groups (G-tube 63.8% vs. G-button 55.7%, p=0.192). More importantly, there were no significant differences in major complications among the groups, G-tube vs. G-button (5% vs. 4%; p=0.455). CONCLUSION Primary G-tube offers no significant advantage in overall, minor or major complications when compared to primary G-button.
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Affiliation(s)
- Hector Osei
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Alice Martino
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Kaveer Chatoorgoon
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Jose Greenspon
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Colleen Fitzpatrick
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Gustavo A Villalona
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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Jeziorczak PM, Frenette RS, Lee J, Coe SC, Aprahamian CJ. Size Matters: Early Gastrostomy Tube Dislodgment in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1372-1375. [PMID: 34492202 DOI: 10.1089/lap.2021.0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Gastrostomy tube (g-tube) complications are typically minor and site related with major complications related to dislodgment before tract establishment. With the recent adoption of 12F g-tubes; size of tube has not been evaluated. There is limited research on the efficacy and dislodgment rates of 12 and 14F g-tubes within the early dislodgment window (<42 days postsurgery). Materials and Methods: A retrospective study from June 1, 2013 to May 25, 2020 was performed. A total of 888 patient encounters were identified, with a final data set of 835 being used for analysis. A subset of 21 patients was evaluated based on early dislodgment status. Fisher's exact test and Welch's two-sample test analyses were used to test for significance between groups (P < .05). Results: The early dislodgment rate is low at 2.5% (21/835). There was a significant impact of g-tube size on dislodgment rates. When evaluated by g-tube size, 12F g-tubes are nearly four times more likely to dislodge before 6 weeks than 14F g-tubes. In addition, the average age of 12F patients who dislodged early was significantly lower than that of the population for 14F patients. Conclusions: There is a significant difference in early dislodgment rate and age between the 12F g-tube compared with a 14F. These data suggest a trade-off of the smaller balloon in 12F g-tubes and potential for more limited use in our smallest children.
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Affiliation(s)
- Paul M Jeziorczak
- Department of Pediatric Surgery, OSF Healthcare- Children's Hospital of Illinois, Peoria, Illinois, USA.,University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
| | - Riley S Frenette
- Department of Pediatric Surgery, OSF Healthcare- Children's Hospital of Illinois, Peoria, Illinois, USA.,Kirksville College of Osteopathic Medicine, AT Still University, Kirksville, Missouri, USA
| | - Joan Lee
- University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
| | - Sarah C Coe
- University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
| | - Charles J Aprahamian
- Department of Pediatric Surgery, OSF Healthcare- Children's Hospital of Illinois, Peoria, Illinois, USA.,University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
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Optimal management of gastrojejunal tube in the ENFit era - Interventions that changed practice. J Pediatr Surg 2021; 56:1430-1435. [PMID: 32921428 DOI: 10.1016/j.jpedsurg.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND We experienced a high incidence of jejunal tube (JEJ) displacement in children who underwent percutaneous endoscopic transgastric jejunostomy (PEGJ), ever since the introduction of ENFit connector (2017). METHODS Two interventions were introduced in 2018 - fixative suture to PEGJ ENFit connector, and conversion to balloon transgastric-jejunal feeding device (Balloon GJ) whenever possible. Children receiving PEGJ and Balloon GJ in 2.8 years were categorized into 3 eras: 2016 (pre-ENFit), 2017 (ENFit) and 2018 (interventional), for comparison of complications and sequelae. Kaplan-Meier survival curves with log-rank test (P < 0.05) were applied. RESULTS 100 children underwent 323 JEJ insertions - PEGJ (n = 237), Balloon GJ (n = 86). Complications occurred in 188 JEJs (58%), more frequently with PEGJ than Balloon GJ (69% vs. 29%, P < 0.0005). PEGJ had higher complication/1000-tube-days (6 vs. 0, P < 0.0005). In 2018, complication rate reduced from 76% to 30% (P < 0.0005) owing to effectiveness of PEGJ connector suture application (P = 0.019), and increased utilization of Balloon GJ (16% to 44%, P = 0.005). Balloon GJ showed better JEJ survival (P = 0.019), less morbidity (emergency attendance, X-ray) and greater cost-effectiveness than PEGJ. CONCLUSIONS Balloon GJ had better overall outcomes than PEGJ. Suture application to connector successfully reduced JEJ internal displacement in PEGJ; however, conversion to Balloon GJ should be strongly considered. LEVEL OF EVIDENCE II.
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Open Primary Button Versus Laparoscopic Percutaneous Endoscopic Gastrostomy: Results From a Case-control Study. J Pediatr Gastroenterol Nutr 2021; 72:e4-e9. [PMID: 32740516 DOI: 10.1097/mpg.0000000000002877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Open primary balloon gastrostomy (PBG) presents a potential alternative to percutaneous endoscopic gastrostomy (PEG) in children as it obviates the need for change under general anaesthetic; however, the complication profile of PBG compared to PEG is not well defined. Previous series comparing the two have been hampered by the groups not being equivalent. Our paediatric surgical centre has offered PBG as an alternative PEG since 2014. We used a matched case-control study to compare outcomes for PBG and PEG. METHODS Patients undergoing PBG were used as "cases" and matched 1:3 by age and diagnosis to patients undergoing PEG, demographics, and clinical data as "controls." Primary outcome was rate of complications classified according to Clavien-Dindo (I-V). Secondary outcomes included time to feed and length of stay. Non-parametric, categorical and multivariate logistic regression analyses were performed. Data here presented as median with interquartile range (IQR). RESULTS We included 140 patients (35 PBG:105 PEG). The 2 groups were comparable for sex, weight at surgery, and follow-up duration. Median operative time was longer for PBG (43 min [IQR 36.5-61.5] vs 27.5 min [18.25-47.75], P < 0.001). Multivariate analysis demonstrated a statistically significant, higher incidence of symptomatic granulation tissue in PBG (10 [29%] vs 6 [6%], P = 0.0008), this remained significant on multivariate analysis (OR 7.56 [2.33-23.5], P = 0.001), no other complication remained significant. The overall complication rate was not statistically different. CONCLUSIONS PBG and PEG have similar overall complication rates; however, PBG appears to have a higher incidence of granulation tissue. This observation must be weighed against the need for further general anaesthetic which is not insignificant in medically complex children.
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Sayadi Shahraki M, Berjis N, Bighamian A, Mahmoudieh M, Shahabi Shahmiri S, Sheikhbahaei E. Minimally invasive technique for gastrostomy tube insertion: A novel laparoscopic approach. Asian J Endosc Surg 2020; 13:610-613. [PMID: 31930718 DOI: 10.1111/ases.12780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/31/2019] [Accepted: 12/01/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) is the most common way of inserting a gastrostomy tube. If PEG is not appropriate for a patient, then the laparoscopic or open technique should be used. Here, we introduce a new laparoscopic technique for inserting a gastrostomy tube. MATERIAL AND SURGICAL TECHNIQUE We used this new laparoscopic approach in 21 patients for whom PEG was not suitable. After marking on the abdominal skin and inserting the trocars, two 2-0 silk sutures were passed. Two stitches were placed 2 cm apart in the stomach with one hand. Each suture was pulled out with the fascia closure, the stomach was pulled out with a Babcock, and a purse-string suture using a round 2-0 silk suture was placed outside the stomach, creating a mushroom-retained gastrostomy. CONCLUSION This new laparoscopic technique is minimally invasive. It provides full control through only two trocars and required smaller incisions than common laparoscopic approaches. This method can be used to insert a gastrostomy tube in indicated patients when PEG placement is not suitable.
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Affiliation(s)
- Masoud Sayadi Shahraki
- Laparoscopic Surgery Fellowship, Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nezamoddin Berjis
- Otorhinolaryngology Department, Kashani University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Bighamian
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Mahmoudieh
- Laparoscopic Surgery Fellowship, Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahab Shahabi Shahmiri
- Laparoscopic Surgery Fellowship, Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Muñoz A, Tan J, Hopper A, Vannix R, Carter H, Woodfin M, Blood A, Baerg J. Cerebral and Renal Oxygenation in Infants Undergoing Laparoscopic Gastrostomy Tube Placement. J Surg Res 2020; 256:83-89. [PMID: 32683061 DOI: 10.1016/j.jss.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/22/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
AIM The aim of this study was to evaluate the effects of a carbon dioxide pneumoperitoneum on cerebral and renal oxygenation and oxygen extraction, in a cohort of infants from the neonatal intensive care unit, undergoing laparoscopic gastrostomy. METHODS After institutional review board approval, between February 2018 and June 2019, infants 0-3 mo corrected age, undergoing laparoscopic gastrostomy tube placement, were included. Strict exclusion criteria created a homogeneous cohort. Cerebral and renal tissue oxygen saturation (rSO2) by near-infrared spectroscopy, skin surface oxygen saturation (SpO2), by pulse oximetry, and amplitude-integrated electroencephalography were measured. Monitoring was divided into preoperative, intraoperative and postoperative time periods. Cerebral and renal fractional tissue oxygen extraction was calculated using arterial (SpO2) and tissue oxygen saturation (rSO2): (SpO2-rSO2SpO2)X100. Data were averaged into one-minute epochs and significant changes from baseline during the intraoperative and postoperative periods were detected using one-way analysis of variance with repeated measures. RESULTS This pilot study examined sixteen infants, born at a median gestational age of 34.2 wk (range: 23.0-40.6) with a median corrected age of 42.9 wk (range: 40.0-46.3) at operation. None had seizure activity or altered sleep-wake cycles. No statistically significant variations in cerebral and renal tissue oxygenation and extraction were observed. Pulse oximetry did demonstrate significant variation from baseline on analysis of variance, but post hoc analysis did not identify any one specific time point at which this difference was significant. CONCLUSIONS During a short infant laparoscopic procedure, no significant alteration in cerebral or renal oxygenation or oxygen extraction was observed. No seizure activity or changes in infant sleep-wake cycles occurred.
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Affiliation(s)
- Amanda Muñoz
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, California.
| | - John Tan
- Division of Biomedical Engineering, Loma Linda University, Loma Linda, California
| | - Andrew Hopper
- Division of Neonatology -Perinatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California
| | - Rosemary Vannix
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - Harmony Carter
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Michelle Woodfin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Arlin Blood
- Division of Neonatology -Perinatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California
| | - Joanne Baerg
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, California
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A Case of Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) for Gastric Volvulus. Case Rep Med 2019; 2019:3468084. [PMID: 31871462 PMCID: PMC6913307 DOI: 10.1155/2019/3468084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/24/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) is the standard modality for long-term enteral nutrition for patients with dysphagia. Compared with open gastrostomy, though PEG is an extremely safe procedure with fewer complications, there are severe cases due to anatomical features. For these cases, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) is the optimal method. Case Presentation A 52-year-old man had a disturbance in swallowing because of cerebral infarction. We attempted PEG under gastrointestinal fiberscope (GIF) and colon fiberscope inspection; however, the procedure was unsuccessful because it was impossible to move the transverse colon downward. We therefore attempted LAPEG to observe the stomach and other organs. Under laparoscopic observation, we diagnosed gastric volvulus, classified as the organo-axial type. For this reason, inserting the tube through the skin was very difficult. We easily corrected the gastric volvulus by using laparoscopic forceps and were finally able to place the PEG tube safely. Discussion Gastric volvulus is rare in clinical practice. The treatment of gastric volvulus depends on whether mucosal ischemia is present. Endoscopic reduction of gastric volvulus is effective for many patients. Surgical treatment should be considered for patients with gastric volvulus that frequently recurs. In our patient, completely inserting the GIF was impossible; therefore, we could not correctly diagnose gastric volvulus. Laparoscopy-assisted PEG is a useful and safe technique for placing a gastrostomy tube in patients presenting with anatomical difficulties. Moreover, in our patient, gastropexy was performed with PEG. Therefore, LAPEG may be used to prevent the recurrence of gastric volvulus. Gastropexy is a useful option in LAPEG. Conclusions Laparoscopy has the advantage of allowing a direct inspection of the stomach while gastrostomy is performed and may reveal complications to PEG insertion. Furthermore, in our patient, gastropexy was performed with PEG.
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Saitua F, Weibel A, Herrera P. Gastrostomy: A percutaneous laparoscopic technique. J Pediatr Surg 2019; 54:2182-2186. [PMID: 31280878 DOI: 10.1016/j.jpedsurg.2019.06.002] [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] [Received: 12/19/2018] [Revised: 04/27/2019] [Accepted: 06/10/2019] [Indexed: 11/25/2022]
Abstract
Several techniques are available for a gastrostomy concomitant with a major abdominal surgery, i.e., there is no 'standard' technique. Here, we present our results of a novel concomitant gastrostomy developed for the Nissen fundoplication. It combines the laparoscopic instrumentation with the kit for percutaneous endoscopic gastrostomy. Once the fundoplication is completed, the gastrostomy is performed in three stages. First, with the orogastric tube and snare, the loop of wire is left in the peritoneal cavity; next, a guide-wire introduced into the peritoneal cavity from the abdominal wall, is taken with the loop, and retrieved at the mouth; finally, the gastrostomy tube is pulled with the guide-wire from mouth to abdominal wall. Only laparoscopic instrumentation is used to choose the site in the stomach, and to perform the puncture; hence, the gastroscope is unnecessary. By choosing the proper sites, stomata are aligned and free of lateral strains making the gentle pressure of the dome enough to appose gastric and abdominal walls; hence, stitches become unnecessary to affix the walls. This percutaneous laparoscopic gastrostomy is simple, brief (ca 21 min), well tolerated, without complications during the intervention or the postoperatory period, reproducible, and of low cost, and exceptional skills are not required. Finally, laparoscopic protocols for a primary gastrostomy may dispel some complications by choosing a 'pull' to install the gastrostomy tube as reported here, instead of the usual 'push'.
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Affiliation(s)
- Francisco Saitua
- Hospital Luis Calvo Mackenna, Santiago, Chile; Universidad de Chile, Santiago, Chile; Clínica Alemana de Santiago, Chile.
| | - Alvaro Weibel
- Hospital Luis Calvo Mackenna, Santiago, Chile; Clínica Alemana de Santiago, Chile
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Osei H, Munoz-Abraham AS, Kim JS, Kazmi S, Myint J, Chatoorgoon K, Greenspon J, Fitzpatrick C, Villalona GA. Perioperative Antibiotics Are Independent Predictors for Major Complications in Pediatric Patients Undergoing Gastrostomy Placement. J Laparoendosc Adv Surg Tech A 2019; 29:1259-1263. [DOI: 10.1089/lap.2019.0316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hector Osei
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | | | - Jin Sun Kim
- Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Sakina Kazmi
- Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Janine Myint
- Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Kaveer Chatoorgoon
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
- Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jose Greenspon
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
- Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Colleen Fitzpatrick
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
- Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Gustavo A. Villalona
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
- Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
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Mason CA, Skarda DE, Bucher BT. Outcomes After Laparoscopic Gastrostomy Suture Techniques in Children. J Surg Res 2018; 232:26-32. [DOI: 10.1016/j.jss.2018.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/05/2018] [Accepted: 05/17/2018] [Indexed: 12/19/2022]
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15
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Fujiogi M, Tanaka Y, Amano H, Deie K, Suzuki K, Kawashima H, Murase N, Uchida H. A new laparoscopic triangle fixation technique for gastrostomy: a safe and effective procedure for reduction of the wound infection rate. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:497-503. [PMID: 30587864 PMCID: PMC6295438 DOI: 10.18999/nagjms.80.4.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Abstract
Gastrostomy is often performed with fundoplication in handicapped children. We devised a new laparoscopic triangle fixation technique for gastrostomy. In this study, 100 patients underwent gastrostomy with fundoplication between January 2008 and January 2016. We retrospectively reviewed the early postoperative results between the new laparoscopic procedure (NLP) group (n = 63) and conventional procedure (CP) group (n = 37). In the CP, the gastrostomy tube was inserted with a purse-string ligature at the gastric wall, and the gastric wall was sutured to the peritoneum under a small laparotomy. In NLP, three sutures were placed on the gastric wall, forming the three sides of a triangle, and the tube was inserted into the center of the triangle. The ends of each suture were pulled directly through the abdominal wall using a laparoscopic percutaneous extraperitoneal closure needle to join the gastric wall and peritoneum. Both groups showed no significant differences in age, body weight, and external leakage rate. The wound infection rate was significantly lower in the NLP group. In conclusions, the NLP is straightforward and can achieve firm fixation between the stomach and abdominal wall by suturing in the form of a triangle. The NLP was associated with a lower complication rate, especially concerning infection.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yujiro Tanaka
- Department of Pediatric surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Pediatric surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Keisuke Suzuki
- Department of Pediatric surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Naruhiko Murase
- Department of Pediatric surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Laparoscopic Gastrostomy in Children: 10 Years of Experience. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:169-172. [PMID: 32595393 PMCID: PMC7315087 DOI: 10.14744/semb.2017.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/26/2017] [Indexed: 11/20/2022]
Abstract
Objectives Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy. Methods The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse-string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally. Results There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day-18 years), and the average body weight was 13 kg (2300 gr-65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate. Conclusion The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.
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Poola AS, Weaver KL, Sola R, Reddy S, Mundakkal A, Fallahian F, Bawa H, Rentea RM, Hendrickson RJ, St. Peter SD. Transabdominal Versus Subcuticular Sutures to Secure a Laparoscopic Gastrostomy. J Laparoendosc Adv Surg Tech A 2018; 28:884-887. [DOI: 10.1089/lap.2017.0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ashwini S. Poola
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Katrina L. Weaver
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Richard Sola
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shiva Reddy
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Angela Mundakkal
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Fedra Fallahian
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Harmeet Bawa
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Rebecca M. Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Shawn D. St. Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
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18
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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: 0.9] [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.
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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
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Kapadia MZ, Joachim KC, Balasingham C, Cohen E, Mahant S, Nelson K, Maguire JL, Guttmann A, Offringa M. A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review. Pediatrics 2016; 138:peds.2015-3967. [PMID: 27365302 DOI: 10.1542/peds.2015-3967] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting. OBJECTIVE To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes. DATA SOURCES Medline, Embase, and Cochrane Register databases searched from inception to March 2014. STUDY SELECTION Articles examining health outcomes of neurologically impaired children living with feeding tubes. DATA EXTRACTION Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development. RESULTS We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes. LIMITATIONS We were unable to investigate effect size of outcomes because quantitative data were not collected. CONCLUSIONS The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS.
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Affiliation(s)
- Mufiza Z Kapadia
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences,
| | - Kariym C Joachim
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Chrinna Balasingham
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Eyal Cohen
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Sanjay Mahant
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Katherine Nelson
- Division of Paediatric Medicine, Institute of Health Policy, Management and Evaluation, and Paediatric Advanced Care Team, Department of Paediatrics, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, and Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Martin Offringa
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
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20
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Volpe P, Domene CE, Santo MA, Cecconello I. Two port video-assisted gastrostomy and jejunostomy: technical simplification and clinical results. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:57-60. [PMID: 25861072 PMCID: PMC4739252 DOI: 10.1590/s0102-67202015000100015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/09/2014] [Indexed: 01/14/2023]
Abstract
Background Patients presenting upper gastrointestinal obstruction, difficulty or inability in
swallowing, may need nutritional support which can be obtained through gastrostomy
and jejunostomy. Aim To describe the methods of gastrostomy and jejunostomy video-assisted, and to
compare surgical approaches for video-assisted laparoscopy and laparotomy in
patients with advanced cancer of the esophagus and stomach, to establish enteral
nutritional access. Methods Were used the video-assisted laparoscopic techniques for jejunostomy and
gastrostomy and the same procedures performed by laparotomies. Comparatively, were
analyzed the distribution of patients according to demographics, diagnosis and
type of procedure. Results There were 36 jejunostomies (18 by laparotomy and 17 laparoscopy) and 42
gastrostomies (21 on each side). In jejunostomy, relevant data were operating time
of 132 min vs. 106 min (p=0.021); reintroduction of diet: 3.3 days vs 2.1 days
(p=0.009); discharge: 5.8 days vs 4.3 days (p= 0.044). In gastrostomy, relevant
data were operative time of 122.6 min vs 86.2 min (p= 0.012 and hospital
discharge: 5.1 days vs 3.7 days (p=0.016). Conclusions The comparative analysis of laparotomy and video-assisted access to jejunostomies
and gastrostomies concluded that video-assisted approach is feasible method, safe,
fast, simple and easy, requires shorter operative time compared to laparotomy,
enables diet start soon in compared to laparotomy, and also enables lower length
of stay compared to laparotomy.
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Affiliation(s)
- Paula Volpe
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos Eduardo Domene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Aurélio Santo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Livingston MH, Pepe D, Jones S, Bütter A, Merritt NH. Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath. Can J Surg 2015. [PMID: 26204365 DOI: 10.1503/cjs.014814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure. METHODS We identified infants, children and young adults who underwent laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a "push" technique with a tear-away sheath. RESULTS We included 92 patients in our study. Mean age was 3.7 years (range 3 wk-5 yr), and mean weight was 11.2 (range 2.8-54) kg. Median procedural time was 20 (range 12-76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures. CONCLUSION Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges.
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Affiliation(s)
- Michael H Livingston
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Daniel Pepe
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Sarah Jones
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Andreana Bütter
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Neil H Merritt
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
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Baker L, Beres AL, Baird R. A systematic review and meta-analysis of gastrostomy insertion techniques in children. J Pediatr Surg 2015; 50:718-25. [PMID: 25783383 DOI: 10.1016/j.jpedsurg.2015.02.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 02/13/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Gastrostomy tubes are inserted via multiple techniques to provide a route for enteral feeding in the pediatric population. This review compares the rate of major complications and resource utilization associated with the various insertion techniques. METHODS Major electronic databases were queried for comparative studies of two or more insertion techniques, including open, laparoscopic, percutaneous endoscopic, or fluoroscopic guided. Major complications were defined as reoperation within 1 year or death. Screening of eligible studies, data extraction, and assessment of methodological quality were conducted independently by two reviewers. Forest and funnel plots were generated for outcomes using Revman 5.1, with p<0.05 considered significant. RESULTS Twenty-two studies with a total of 5438 patients met inclusion criteria. No differences in major complications were noted in studies comparing open versus laparoscopic approaches or open versus PEG. Studies comparing laparoscopic gastrostomy and PEG revealed a significantly increased risk in major complications with PEG (n=10 studies, OR 0.29, 95% CI: 0.17-0.51, p<0.0001). The number needed to treat to reduce one major complication by abandoning PEG is 45. CONCLUSIONS PEG is associated with an increased risk of major complications when compared to the laparoscopic approach. Advantages in operative time appear outweighed by the increased safety profile of laparoscopic gastrostomy insertion.
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Affiliation(s)
| | - Alana L Beres
- Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada; McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Baird
- Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada; McGill University Health Centre, Montreal, Quebec, Canada.
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23
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Immune therapies for lung cancer. J Thorac Oncol 2012; 7:S394-6. [PMID: 23160331 DOI: 10.1097/jto.0b013e31826df203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Timratana P, El-Hayek K, Shimizu H, Kroh M, Chand B. Percutaneous endoscopic gastrostomy (PEG) with T-fasteners obviates the need for emergent replacement after early tube dislodgement. Surg Endosc 2012; 26:3541-7. [DOI: 10.1007/s00464-012-2348-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 04/12/2012] [Indexed: 12/23/2022]
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