Persistent gastrocutaneous fistula: factors affecting the need for closure

Area of Science:

• Gastroenterology
• Surgical Complications
• Pediatric Surgery

Background:

• Gastrocutaneous fistula (GCF) is a known complication following gastrostomy tube (GT) placement.
• Identifying risk factors for persistent GCF is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the impact of various factors on the incidence of persistent GCF after GT removal.
• To determine associations between GCF and surgical approach, concomitant procedures, patient demographics, and device duration.

Main Methods:

• Retrospective review of patient records for gastrostomy placements between 2007 and 2011.
• Logistic regression analysis to evaluate the association of GCF with placement method, fundoplication, neurological status, duration, and demographics.

Main Results:

• Of 148 patients with GT removal, 47 (32%) developed persistent GCF requiring surgical closure.
• Open procedures (43%) had a higher GCF rate than laparoscopic (22%).
• Concurrent Nissen fundoplication (44% vs. 21%), longer device duration, and younger age at placement were significantly associated with increased GCF risk.

Conclusions:

• Open surgical operations for gastrostomy placement are associated with a higher risk of persistent GCF.
• Concurrent Nissen fundoplication and younger age at the time of gastrostomy tube placement are significant risk factors for developing persistent GCF.