Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study (original) (raw)
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Assessing Clinical Outcomes Post Modified Laparoscopic Gastrostomy in Children: a Case Control Study
2021
BackgroundGastrostomy has become a common surgical procedure within the pediatric population with feeding difficulties and nutritional issues. In the aims of improving clinical outcomes, this research targets to compare the rate of complications of two different laparoscopic techniques of a gastrostomy button placement in a pediatric population: A combination of modified U-stitches and seldinger technique laparoscopic gastrostomy (MLG) versus the standard laparoscopic gastrostomy (LG).MethodsEighty-nine children were recruited for this retrospective case control study that assesses the surgical outcomes of a novel MLG, being the cases to the standard LG in children which are the controls. The main outcome measure 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.ResultsThe p-value of the study was shown ...
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2006
Background: Gastrostomy tube placement is among the most common gastrointestinal procedures performed in children. The U-stitch laparoscopic technique allows primary button placement and the advantages of laparoscopy. The purpose of this study was to quantify the completion rate and the occurrence of complications in a large single-institution experience. Materials and Methods: All laparoscopic gastrostomy procedures between April 2000 and May 2005 were reviewed. Complications that required operative treatment or hospital readmission were classified as early (Ͻ90 days) or late (Ն90 days). Results: Laparoscopic gastrostomies were created in 461 patients during the study period with primary buttons being placed in 444 (96%). No procedure-related deaths occurred. Early complications included: reoperation secondary to tube dislodgement in 7 patients (1.5%), herniation of omentum postoperatively in 3 patients (0.6%), and development of granulation tissue or everted gastric mucosa requiring excision in 13 patients (3.2%). Late complications occurred in 8 patients (1.7%), with three (0.7%) requiring revision of the gastrostomy due to local site problems. Five patients (1.1%) had intraperitoneal placement of tubes during attempted replacement after 90 days. Age, infancy, and neurological impairment were not associated with a higher rate of complications. Conclusion: The U-stitch gastrostomy technique is safe and allows primary button placement in infants and children. Its complication rate compares favorably to other reported gastrostomy techniques.
Laparoscopic Gastrostomy in Children: Ten Years Experience
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital
G astrostomy practice provides long-term enteral feeding in children whose energy and nutritional requirements are not entirely achieved by oral nutrition, and it is generally required in patients with cardiac and neurological deficits. [1, 2] The basic approach in gastrostomy for a long time usually consisted of open gastrostomy using the Stamm technique. [3] Since the application of the Stamm technique, minimal invasive procedures such as percuta-neous endoscopic gastrostomy and laparoscopic gastrostomy (LG) have been developed. [4] With the development of laparoscopic surgery in children, application of LG has also gained popularity. [1] The LG application was first cited in the literature in 1991. [5] Since its implementation, LG has undergone different modifications to reduce its complication rates and facilitate the operation technique. [6-9] 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.
A comparison of techniques for laparoscopic gastrostomy placement in children
Journal of Surgical Research, 2013
Pediatrics a b s t r a c t Background: The insertion of gastrostomy tube (GT) for children is typically accomplished using a minimally invasive approach. There is considerable variability in the technical details of this operation, depending on how much of the procedure is performed intracorporeal. The purpose of this study is to compare the outcomes and resource utilization of two differing techniques for laparoscopic GT insertion in the pediatric population.
Pediatric Surgery International
Purpose A meta-analysis was performed to compare the rates of the major complications associated with two gastrostomy tube placement techniques in a pediatric population: laparoscopy-assisted gastrostomy (LAG) and percutaneous endoscopic gastrostomy (PEG). Methods The PubMed electronic database was queried for comparative studies of the two insertion techniques. The Newcastle-Ottawa scale (NOS) was used for the assessment of the quality and risk of bias in the included studies. The main outcome measure was the frequency of major complications defined as the need for reoperation within 30 days or death. RevMan 5.3, was used, with a p < 0.05 indicating statistical significance. Results Eight studies including 1550 patients met the inclusion criteria. The risk for major complications was higher in PEG than in LAG 3.86 (95% confidence interval 1.90-7.81; p < 0.0002). The number needed to treat to reduce one major complication by performing LAG instead of PEG was 23. There were no randomized-controlled trials. Overall, the quality of the included studies was determined to be unsatisfactory. Conclusions PEG placement was associated with a significantly higher risk of major complications compared to LAG placement. Therefore, LAG should be the preferred method for gastrostomy tube placement in children.
Complications of laparoscopy-aided gastrostomies in pediatric practice
Journal of Pediatric Surgery, 1999
The aim of this report is to establish the frequency lems were common, necessitating medical attention postopand type of complications of laparoscopy-aided gastrostomy erativeiy. Patients with congenital heart disease, chronic in pediatric practice and to identify patients at risk for respiratory failure, and metabolic diseases experienced the postoperative complications. highest frequency of postoperative complications. Method: This is a follow-up study of 98 children with nutritional problems including inability to swallow, inadequate calorie intake in neurologically impaired children, patients with cystic fibrosis, malignancies, neurometabolic diseases, and cardiac malformations. Laparoscopy-aided gastrostomy was attempted in all patients. These patients have undergone follow-up at our outpatient clinic. Postoperative complications and problems with the gastrostomy device were registered. The postoperative complications were divided into minor problems and major or life-threatening complications. Conclusions: The surgical placement of an enteral access device in children should be considered a major surgical procedure, demanding medical attention for 1 to 2 months postoperatively. The rate and severity of complications with the method described are tolerable considering the severity of the underlying diseases.
Surgical Endoscopy, 2014
Introduction A gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. However, data on efficacy, perioperative complications and postoperative gastroesophageal reflux (GER) after laparoscopic gastrostomy (LAG) placement is limited. The aim of this study is to evaluate long-term efficacy and adverse events after LAG in a large cohort and determine whether routine preoperative 24-h pH monitoring should be used to predict postoperative GER. Method A retrospective observational cohort study was performed including 300 patients (75 % neurologically impaired) that underwent LAG. Results After a median follow-up of 2.63 years, feeding was successful in 95.9 % of patients. Weight-for-length z-scores significantly increased (p \ 0.0005). Major complications were seen in only 6 patients (2.0 %), but minor complications occurred frequently (73.6 %). Overall incidence of GER remained unchanged after LAG. Sensitivity and specificity of preoperative pH monitoring were 17.5 and 76.9 %, respectively. Conclusion LAG placement in pediatric patients leads to successful feeding in 96 % of patients and serious adverse events are rare. However, the minor complication rate is high. Overall incidence of GER does not increase after LAG. Preoperative 24-h pH monitoring is not a reliable tool to predict postoperative GER. This invasive investigation technique should therefore not be routinely performed.
2021
Objectives: Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) is a wellrecognised technique used for the placement of gastrostomies in patients with complex medical conditions or postsurgical difficult anatomy. We introduced LAPEG in our centre to improve outcome and increase safety in our complex paediatric population. We aim to review the outcome and complications of LAPEG in children since our change in practice. Methods: A retrospective tertiary centre review over 9 years (September 2010September 2019) was conducted. Children under 16 years undergoing LAPEG were reviewed for risk factors and major complications. Results: 76 patients were identified, 44 males. Median age was 1 year (1 month–14 years), median weight was 8.4 kg (2.8-33.9 kg). A third was less than 7 kg and a third were in Paediatric Intensive Care Unit at the time of the procedure. A quarter had underlying congenital heart disease, a quarter had previous abdominal surgery and 15% (11/76) had America...
2010
Objective. This study compares laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a paediatric population to test the hypothesis that there is a difference in the frequency of serious gastrointestinal complications between the two methods. Methods. All reports published between 1995 and 2009 on laparoscopic gastrostomy and PEG in children was included. Prospective and retrospective trials, comparing the two methods or dealing with one of them only were included. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Results. 822 publications were found when using the search terms: gastrostomy, gastrointestinal complications, and all child: 0-18 years. From these, 54 studies were extracted for this investigation. These studies reported a total of 4331 children undergoing gastrostomy operation, 1027 by using the laparoscopic technique and 3304 using the PEG technique. The number of serious gastrointestinal fistulas to colon or small bowel was 0% and .27%, respectively, P < .05. Conclusions. The results suggest that by performing laparoscopic gastrostomy in children it is possible to avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG.
Gastrostomy Placement in Children: Percutaneous Endoscopic Gastrostomy or Laparoscopic Gastrostomy?
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2016
The aim of this study is to compare the outcomes and the complications between the 2 most adopted procedures for gastrostomy placement: percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) in children. We present our study on 69 patients (male: 46/female: 23): group 1 (37 patients, 54%) undergoing PEG, group 2 (32 patients, 46%) undergoing LG. A total of 5 major complications were observed all in the PEG group (13.5%), no major complication was observed in the LG group (P-value < 0.05). A total of 12 minor complications were observed: 4 occurred in the PEG group (10.8%) and 8 (25%) in the laparoscopic gastrostmoy group, not statistically relevant. We suggest that the LG should be considered the preferred technique for gastrostomy placement in pediatric patients, particularly in newborns, children with significant skeletal malformations, and patients who underwent previous abdominal surgery.