Modified laparoscopic gastrostomy technique reduces gastrostomy tract dehiscence

Area of Science:

• Pediatric Surgery
• Minimally Invasive Procedures
• Gastroenterology

Background:

• Gastrostomy tube placement is common in pediatric patients.
• Disruption of the gastrostomy tract requiring reoperation is a known complication.
• The Georgeson technique is a laparoscopic approach for gastrostomy tube placement.

Purpose of the Study:

• To describe a modified Georgeson technique for laparoscopic gastrostomy tube (LGT) placement.
• To compare reoperation rates for tract disruption after modified LGT to percutaneous endoscopic gastrostomy (PEG) and published LGT/PEG data.

Main Methods:

• Modification of the Georgeson technique in 2003 to include laparoscopic sutures securing the stomach to the abdominal wall.
• Retrospective review of pediatric LGT and PEG placements from March 2003 to October 2009.
• Literature review for published complication rates of LGT and PEG procedures.

Main Results:

• 85 modified LGTs and 34 PEGs were placed. No modified LGTs required reoperation for tract disruption.
• 5.9% of modified LGTs experienced early dislodgement (<14 days), but none required reoperation.
• PEG group had 2 reoperations for dislodgement/tract disruption (5.8% total). Published reoperation rates for LGTs are 2.6% and for PEGs are 4%-6%.

Conclusions:

• The modified Georgeson technique effectively reduces reoperations for gastrostomy tract disruption.
• This surgical modification enhances the safety and efficacy of laparoscopic gastrostomy tube placement.
• The technique shows promise in improving outcomes for pediatric patients requiring gastrostomy tubes.