Extraperitoneal closure of persistent gastrocutaneous fistula in children
Gustavo Stringel1, Whitney McBride, Allison Sweny
1Department of Pediatrics, NY Medical College, Valhalla, NY 10595, USA. GStringel@aol.com
Insights
A novel extraperitoneal technique safely and effectively closes persistent gastrocutaneous fistulas in children. This method allows for early feeding resumption and shorter hospital stays with minimal complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Gastrostomy feeding is crucial for pediatric nutritional support.
- Persistent gastrocutaneous fistulas require surgical intervention after gastrostomy tube removal.
- Standard treatment involves laparotomy, which is invasive.
Purpose of the Study:
- To describe and evaluate an extraperitoneal technique for gastrocutaneous fistula closure.
- To assess the safety and efficacy of this novel approach in pediatric patients.
Main Methods:
- Review of 21 pediatric cases using a Foley catheter traction technique for extraperitoneal closure.
- Core excision of the fistulous tract with electrocautery.
- Closure without fascial separation, enabling early feeding.
Main Results:
- Successful closure in 20 out of 21 patients.
- Mean gastrostomy duration of 3.3 years; mean repair time of 4.3 months.
- One superficial wound infection and one recurrence requiring intraperitoneal closure.
Conclusions:
- Extraperitoneal closure is a safe and effective treatment for pediatric gastrocutaneous fistulas.
- The technique facilitates rapid feeding resumption and reduces hospital stay.
- Minimal morbidity and good tolerability in the pediatric population.
Background And Objectives:
Gastrostomy feeding in children is well established for nutritional support. Gastrostomy tubes may be permanent or temporary. After removal, spontaneous closure may occur, but persistence of the tract requires surgical repair. Laparotomy with gastric repair and fascial closure is the standard technique for treatment of a persistent gastrocutaneous fistula. We describe a technique of extraperitoneal excision of the fistulous tract and our results using this method.
Methods:
We reviewed 21 cases of extraperitoneal gastrocutaneous fistula closure in which a Foley catheter traction technique was used and were performed over the last 8 y. The technique involves insertion of a small Foley catheter with traction applied to the fistulous tract and core excision with electrocautery. Closure of the tract without fascial separation was accomplished and early feedings were allowed.
Results:
Ten males and 11 females underwent closure with this technique. The duration of the gastrostomy ranged from 1 y to 6 y, with a mean of 3.3 y. The time from removal to surgical repair was 3 wk to 1 y, with a mean of 4.3 mo; 15 had gastrostomy alone, and 6 had gastrostomy in combination with Nissen fundoplication. Open gastrostomy had been done in 10 patients and laparoscopic gastrostomy in 11 patients. Half of the patients had an ambulatory procedure. One patient developed a superficial wound infection, and there was 1 recurrence requiring intraperitoneal closure.
Conclusion:
Extraperitoneal closure for gastrocutaneous fistula is safe and effective. The technique allows for rapid resumption of feeds and a shortened length of stay. Minimal morbidity occurs with this technique, and it is well tolerated in the pediatric population.
