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Peristomal infection in percutaneous endoscopic gastrostomy (PEG): a comparative study of two gastropexy techniques
Paulo Moacir Oliveira Campoli1, Daniela Medeiros Milhomem Cardoso, Marília Dalva Turchi
1Department of Digestive Endoscopy, Aradjo Jorge Hospital, Goiânia, Goiás, Brazil. paulomar@ih.com.br
Introduction:
Percutaneous endoscopic gastrostomy (PEG) performed using the Pull technique is associated with a high rate of surgical infections. When PEG is performed using the Introducer technique, a lower rate of infection is seen. However, this technique can pose technical difficulties during gastropexy. Gastropexy using two straight needles, our initial method, causes the snare to be in contact with the sterile suture. We have recently used an original gastropexy technique performed with a long curved needle in which there is no contamination of the sterile suture. The aim of this study is to compare the rates of infection observed with these two methods of gastropexy.
Methods:
The Introducer technique was performed in all patients with two different gastropexy techniques used during two separate, consecutive periods. Antibiotic prophylaxis was not used during either procedure. Any surgical infections were treated with local wound care and/or antibiotic therapy with treatment based on the severity of the infection. The surgical infection rates in each group were compared.
Results:
Group I consisted of 142 patients who underwent gastropexy with two straight needles, and group II consisted of 435 patients on whom gastropexy was performed with a curved needle. The infection rates found in groups I and II were 2.8% and 0.2%, respectively (P = 0.03).
Conclusions:
Gastropexy performed with a curved needle was associated with a lower rate of infection when compared to gastropexy performed with two straight needles.
Insights
A curved needle gastropexy technique significantly reduced surgical site infections compared to the traditional two straight needles method during percutaneous endoscopic gastrostomy (PEG) procedures. This finding highlights a safer approach for PEG placement.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Infection Control
Background:
- Percutaneous endoscopic gastrostomy (PEG) using the Pull technique has high surgical infection rates.
- The Introducer technique for PEG reduces infections but presents gastropexy challenges.
- Previous gastropexy methods risked sterile suture contamination.
Purpose of the Study:
- To compare surgical infection rates between two gastropexy techniques in PEG procedures.
- To evaluate the efficacy of a novel curved needle gastropexy method.
- To determine if a modified gastropexy technique reduces PEG-related infections.
Main Methods:
- A comparative study using the PEG Introducer technique with two distinct gastropexy methods.
- Group I: Gastropexy with two straight needles (n=142).
- Group II: Gastropexy with a long curved needle (n=435).
- No antibiotic prophylaxis was used; infections were treated based on severity.
Main Results:
- Infection rates were 2.8% in the straight needle group (Group I) and 0.2% in the curved needle group (Group II).
- The difference in infection rates was statistically significant (P = 0.03).
- The curved needle technique demonstrated a substantial reduction in surgical site infections.
Conclusions:
- Gastropexy with a curved needle is associated with significantly lower infection rates than using two straight needles.
- This modified technique offers a safer alternative for PEG placement.
- The study supports the adoption of the curved needle method for reducing PEG-associated infections.
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