Parental satisfaction and long term standardized outcome evaluation after percutaneous endoscopic vs laparoscopic...

Percutaneous endoscopic (PEG) and laparoscopic gastrostomy (LG) are two widely used techniques for gastrostomy placement in infants. We aimed to compare the risk of complications using a validated grading system and parent satisfaction.

Infants undergoing gastrostomy placement in a tertiary referral center were retrospectively included. Local and general complications were graded using the Clavien-Dindo (CD)system and categorized as early (≤ 30 days) vs late (>30 days) postoperatively. Parent satisfaction was evaluated prospectively using a questionnaire (Numeric Rating Scale 0- 10).

Out of 102 patients, 52 underwent LG and 50 PEG. General complications (CD IIIa, IIIb and IV) were rare and occurred all late (n = 3), local complications were common: twice as much minor local early complications occurred in the LG cohort, however this was not statistically significant (28.8% vs 14.0%; p = 0.092). There was a trend toward more major local late CD IIIb complications in the PEG group, but this was not statistically significant (20.4% vs 8.0%; p = 0.088). After button removal, there was a higher risk of gastrocutaneous fistula requiring surgical closure after LG (53.1% vs 26.7% after PEG; p = 0.003). Parental satisfaction was high in both groups (mean score 8.3 for PEG vs 7.9 for LG; p = 0.341).

While the risk of general complications after gastrostomy placement is low, local complications are common. However not significant, PEG was associated with a higher risk of major long-term local complications, while LG required more surgical closures after button removal. Parental satisfaction was high in both groups. Further prospective comparisons are needed.