Pediatric Gastrostomy Tube Placement: Avoid the Incision to Avoid the Complications

Background: Tremendous practice variation exists for placing gastrostomy tubes. The objective of this study was to determine if the operative approach is associated with 30-day complication rates. Methods: This single-center retrospective cohort study identified pediatric patients who underwent gastrostomy tube placement from June 2019 to April 2022. Gastrostomy approaches included laparoscopic, laparoscopic-assisted (incision at gastrostomy site), modified open (incision at gastrostomy site), and percutaneous endoscopic gastrostomy (PEG). Multivariable logistic regression models were performed to evaluate the association of 30-day complications and operative approach after controlling for prematurity and weight. Results: Among 521 gastrostomy patients, the median age was 10 months (interquartile range: 4-33 months), and 181 (34.9%) had a history of prematurity. Weight categories included 217 (41.6%) underweight, 272 (52.2%) normal weight, and 32 (6.1%) overweight. Patients underwent laparoscopic (n = 386, 74.1%), laparoscopic-assisted (n = 73, 14.0%), modified open (n = 33, 6.3%), and PEG (n = 27, 5.2%). Complications included reoperation (n = 17, 3.3%), readmission (n = 12, 2.3%), wound infection (n = 30, 5.8%), wound breakdown (n = 21, 4.0%), tube dislodgement (n = 23, 4.4%), granulation tissue (n = 107, 20.5%), and leakage (n = 33, 6.3%). Following adjustment, laparoscopic-assisted gastrostomy was associated with higher odds of any complication. Laparoscopic-assisted and modified open were associated with higher odds of wound breakdown. Laparoscopic-assisted and modified open were associated with higher odds of leakage. The operative approach was not associated with reoperation, readmission, wound infection, or tube dislodgement. Conclusions: Techniques for gastrostomy placement, which include an incision around the tube, were associated with higher rates of complications. To improve complication profiles for patients, surgeons should consider laparoscopic or percutaneous endoscopic gastrostomies.