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Risk Factors for a Persistent Gastrocutaneous Fistula Following Gastrostomy Device Removal: A Tertiary Center
Abdulrahman Alshafei1, Dawn Deacy1, Brice Antao1
1Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
Insights
Younger age, longer device duration, open insertion, and site infections are key risk factors for persistent gastrocutaneous fistulas (GCF) after gastrostomy device (GD) removal in children. Identifying these factors aids patient counseling.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Gastrocutaneous fistulas (GCF) can persist after gastrostomy device (GD) removal.
- Identifying risk factors for persistent GCF is crucial for managing pediatric patients.
Purpose of the Study:
- To identify risk factors associated with persistent GCF following GD removal in children.
- To inform patient counseling and management strategies.
Main Methods:
- Retrospective analysis of 59 pediatric patients undergoing GD insertion and removal (2005-2015).
- Patients categorized into persistent GCF (Group A) or spontaneous closure (Group B).
- Analysis of demographics, comorbidities, device details, and procedural factors using Chi-square and ANOVA tests.
Main Results:
- 34 patients developed persistent GCF post-GD removal.
- Younger age at insertion (<2 years), longer device placement duration, open insertion technique, device upsizing, tube-to-button changes, and site infections were significant risk factors.
- Underlying comorbidities did not impact spontaneous closure.
Conclusions:
- Persistent GCF after GD removal is influenced by several identifiable risk factors.
- Potentially reversible factors like site infections and insertion methods were identified.
- Risk analysis is vital for pre-procedural patient counseling and optimizing GD management.
Aim:
The aim of this study is to identify the risk factors for a persistent gastrocutaneous fistula (GCF) after gastrostomy device (GD) removal in children.
Materials And Methods:
A retrospective analysis of 59 patients that underwent GD insertion and removal over an 11-year period (2005-2015). Patients were divided into two Groups (A and B) according to persistence or closure of the gastrocutaneous tract. Data included patient demographics, comorbidities, age at insertion, gastrostomy site infections, size and type of device, duration of placement, and method of insertion and removal. Statistical analysis was done using Chi-square test and ANOVA test where P < 0.05 was considered statistically significant.
Results:
A total of 34 patients (Group A) developed a GCF post-GD removal. The gastrostomy tract closed spontaneously in 25 patients (Group B). Underlying comorbidities did not influence spontaneous closure. Younger age at insertion (<2 years), longer duration of device placement, open gastrostomy insertion, upsizing the GD, changing a gastrostomy tube to a button, and site infections were significant risk factors for a persistent GCF.
Conclusions:
Risk analysis of persistent GCF is important for patient counseling before removal or replacement of the GD. We have identified a number of potentially reversible risk factors for a persistent GCF and have made recommendations accordingly.
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