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Complication rate after gastrostomy placement in children can be reduced by simple surgical steps
Therese Hössjer1, Gunnar Göthberg2, Einar Arnbjörnsson3
1Department of Pediatric Surgery, Akademiska Sjukhuset, Institution of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Insights
Choosing the correct gastrostomy tube size can reduce complications. A 12 Fr tube, 2 mm longer than the stoma, is associated with fewer issues in children. Oncological patients experienced fewer granulomas.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastrostomy placement is common in children.
- Postoperative complications can occur, impacting patient outcomes.
Purpose of the Study:
- To identify perioperative factors and patient characteristics associated with gastrostomy placement complications.
- To optimize gastrostomy tube selection for improved surgical outcomes in pediatric patients.
Main Methods:
- Prospective observational study of 582 children (<18 years) undergoing gastrostomy placement (2014-2019).
- Collection of pre-, peri-, and postoperative variables, with 3-month follow-up.
- Statistical analysis, including multivariate analysis, to assess correlations.
Main Results:
- A 12 Fr gastrostomy tube, 2 mm longer than the gastrostomy canal, correlated with lower complication rates (p<0.001-0.025).
- Multivariate analysis confirmed the significance of tube length and thickness, independent of operative technique, age, and weight.
- Oncological patients had higher rates of pain and infection but lower rates of granulomas (p<0.001-0.01).
Conclusions:
- A 12 Fr gastrostomy tube, 2 mm longer than the gastrostomy canal, is associated with the lowest incidence of postoperative complications within 3 months.
- The lower incidence of granulomas in oncological patients may be linked to chemotherapy treatments.
Aim:
To evaluate if the incidence of postoperative complications after gastrostomy placement is correlated to perioperative parameters or patient characteristics.
Methods:
In this prospective observational study, children <18 years of age planned to receive a gastrostomy at partaking clinics between 2014 and 2019 were invited. Pre-, peri- and postoperative variables were collected and followed up 3 months postoperatively.
Results:
Five hundred and eighty-two patients were included (median age: 26 months, median weight: 10.8 kg), mainly laparoscopic (52.0%) and push-PEG (30.2%) technique used. The incidence of complications was lower in the group of patients receiving a gastrostomy tube that was 2 mm longer than the gastrostomy canal (p < 0.001-0.025), and a thickness of 12 Fr (p < 0.001-0.009). These findings were confirmed by multivariate analysis also including operative technique, age and weight. Patients with oncological disease had significantly higher incidence of pain and infection but the lowest incidence of granulomas (p < 0.001-0.01).
Conclusion:
This study indicates that a 12 Fr gastrostomy tube that is 2 mm longer than the gastrostomy canal is correlated with the lowest incidence of postoperative complications the first 3 months after surgery. Oncological patients had the lowest incidence of granulomas which probably is related to chemotherapy.
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