Primary gastrostomy button: a means of long-term enteral feeding in children

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Devices

Background:

• Enteral feeding is crucial for children with conditions like intellectual handicap, cystic fibrosis, and severe gastroesophageal reflux.
• Gastrostomy buttons provide a long-term solution for nutritional support in pediatric patients.

Purpose of the Study:

• To evaluate the efficacy and safety of primary gastrostomy buttons for long-term enteral feeding in children.
• To compare the longevity and complication rates of different gastrostomy button insertion methods.

Main Methods:

• Retrospective analysis of 94 primary gastrostomy button insertions in 42 pediatric patients between 1992 and 1997.
• Categorization of indications including intellectual handicap, cystic fibrosis, and gastroesophageal reflux.
• Comparison of outcomes based on concomitant surgical procedures: open fundoplication, primary open button, and laparoscopic fundoplication.

Main Results:

• The average button longevity was 388.36 days, with minimal stomal complications and no cases of gastric separation or peritonitis.
• Bard buttons were primarily removed due to valve incompetence and flap damage; Mic-key buttons due to balloon leakage.
• Laparoscopic fundoplication group showed significantly lower button longevity compared to other groups.

Conclusions:

• Primary gastrostomy button insertion is a preferable method for long-term enteral feeding in children due to acceptable longevity and low complication rates.
• Different button types (Bard, Mic-key) have distinct failure modes, requiring specific management.
• Concomitant laparoscopic fundoplication may impact gastrostomy button longevity.