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Safety of percutaneous endoscopic gastrostomy after trauma laparotomy
Elizabeth A Wyman1, Rachel M Nygaard1, Chad J Richardson1
1Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota.
Insights
Percutaneous endoscopic gastrostomy (PEG) placement is safe in trauma patients, even after recent laparotomy. This study found no increased complication rates, suggesting it should not be a contraindication for enteral access.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Trauma Care
Background:
- Trauma patients often need long-term enteral access due to head, neck, or GI injuries.
- Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiographic gastrostomy (PRG) are common noninvasive methods.
- PEG placement is often avoided in patients with recent trauma laparotomy due to concerns about altered anatomy.
Purpose of the Study:
- To investigate the safety and efficacy of PEG placement in trauma patients with and without a history of laparotomy.
- To determine if recent trauma laparotomy increases complication rates for PEG placement.
Main Methods:
- Retrospective review of percutaneous gastrostomies (PEG and PRG) in trauma patients at a level I trauma center (2007-2010).
- Analysis of 354 patients' electronic medical records up to 30 days post-procedure.
- Patients were stratified based on prior laparotomy history; statistical analysis used Fisher exact test or t-test.
Main Results:
- Successful PEG placement rates were 92.2% in patients without prior laparotomy and 82.4% in those with prior laparotomy.
- PEG placement failure rates were 2.0% and 11.8% in patients without and with prior laparotomy, respectively.
- The overall complication rate was 2.0%, with no complications reported in patients with prior trauma laparotomy.
Conclusions:
- Recent trauma laparotomy should not be considered a contraindication for PEG placement.
- PEG placement can be safely performed in trauma patients with a history of laparotomy.
- Adherence to basic safety principles is crucial for successful PEG placement in this population.
Background:
Trauma patients frequently require long-term enteral access because of injuries to the head, neck, or gastrointestinal tract. Noninvasive methods for gastrostomy placement include percutaneous endoscopic gastrostomy (PEG) and percutaneous radiographic gastrostomy (PRG). In patients with recent trauma laparotomy, PEG placement is felt to be relatively contraindicated because of the concerns about altered anatomy. We hypothesize that there is no increased rate of complications related to PEG placement in patients with trauma laparotomy compared with those without laparotomy provided that basic safety principles are followed.
Materials And Methods:
This retrospective study evaluates all percutaneous gastrostomies (both PEG and PRG) placed in trauma patients admitted at a level I trauma center between January 1, 2007 and March 30, 2010. The electronic medical records of the 354 patients were reviewed through 30 days after procedure, and patients were further subdivided by the history of laparotomy. Statistical analysis was performed using Fisher exact test or two-tailed t-test, as appropriate.
Results:
In patients with no prior trauma laparotomy, successful PEG placement occurred in 92.2% of patients, the remainder underwent PRG placement. Of patients with prior trauma laparotomy, 82.4% had successful PEG placement. Two percent of attempted PEG placements failed in patients with no previous trauma laparotomy, whereas 11.8% failed in patients with recent trauma laparotomy. The overall complication rate was 2.0%, with no recorded complications in patients with trauma laparotomy before PEG placement.
Conclusions:
These data suggest that surgeons should not consider recent trauma laparotomy a contraindication to PEG placement.
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