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Single Center Experience with Gastrostomy Insertion in Pediatric Patients: A 10-Year Review
Jiyoung Kim1, Hong Koh1, Eun Young Chang1
1Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
This 10-year review of pediatric gastrostomy insertion found similar complication rates across endoscopic, laparoscopic, and open methods. An algorithm was introduced to guide method selection for improved outcomes in pediatric gastrostomy procedures.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Surgical outcomes
Background:
- Gastrostomy tubes are essential for pediatric nutritional support.
- Selecting the optimal insertion method is crucial for minimizing complications.
- Varied outcomes necessitate a review of long-term results.
Purpose of the Study:
- To review the outcomes of gastrostomy insertion in pediatric patients over a decade.
- To evaluate complication rates associated with different gastrostomy insertion methods.
- To introduce and assess an algorithm for selecting the least invasive gastrostomy procedure.
Main Methods:
- Retrospective chart review of 236 pediatric patients undergoing gastrostomy insertion (October 2005 - March 2015).
- Application of a predefined algorithm to determine the least invasive method for each patient.
- Long-term follow-up to analyze method-specific complications.
Main Results:
- Endoscopic gastrostomy (n=120), laparoscopic gastrostomy (n=79), and open gastrostomy (n=37) showed comparable major complication rates (9.2%, 8.9%, 8.1%).
- Gastroesophageal reflux was the most frequent major complication (3.8%), followed by peritonitis, hiatal hernia, and bowel perforation.
- Gastrostomy removal success rates were 8.6% (endoscopic) and 5.0% (surgical); gastrocutaneous fistula occurred in 60% of surgical cases.
Conclusions:
- Gastrostomy insertion in children yields comparable complication rates across endoscopic, laparoscopic, and open approaches.
- An algorithm can aid in selecting the least invasive method, but further studies are needed for consensus.
- Long-term outcomes and specific complication profiles warrant continued investigation for optimizing pediatric gastrostomy care.
Purpose:
This study was performed to review the outcomes of gastrostomy insertion in children at our institute during 10 years.
Methods:
A retrospective chart review was performed on 236 patients who underwent gastrostomy insertion from October 2005 to March 2015. We used our algorithm to select the least invasive method for gastrostomy insertion for each patient. Long-term follow-up was performed to analyze complications related to the method of gastrostomy insertion.
Results:
Out of 236 patients, 120 underwent endoscopic gastrostomy, 79 had laparoscopic gastrostomy, and 37 had open gastrostomy procedures. The total major complication rates for endoscopic gastrostomy insertion, laparoscopic gastrostomy insertion, and open gastrostomy were 9.2%, 8.9%, and 8.1%, respectively. The most common major complication was gastroesophageal reflux requiring Nissen fundoplication (3.8%), and other complications included peritonitis (1.3%), hiatal hernia (1.3%), and bowel perforation (0.8%). Gastrostomy removal was successful in 8.6% and 5.0% of patients in the endoscopic and surgical gastrostomy groups, respectively. Gastrocutaneous fistula occurred in 60% of surgically inserted cases, requiring a second operation.
Conclusion:
This retrospective study was performed to review the outcome of gastrostomy insertion, as well as to introduce an algorithm that can be used for future cases. Further studies should be conducted to make a consensus on choosing the most appropriate method for gastrostomy insertion.