Laparoscopic gastrostomy tube placement: impact of suture technique on short-term outcomes

Technique for pediatric laparoscopic gastrostomy tube placement often differs by suture technique and material for gastric fixation. Two variations are used- one where sutures are tied externally temporarily, and the other where sutures are backed subcutaneously and buried under the skin.

After Morbidity and Mortality reviews, we noted a potentially higher than expected post operative complication rate following laparoscopic gastrostomy tube placement. Subsequently a retrospective review of patients who underwent laparoscopic gastrostomy tube placement over a 28-month period was performed to further evaluate the short-term complication rates of stitch abscess, cellulitis, granulation tissue, tube dislodgement, and emergency department (ED) visits.

126 laparoscopic gastrostomy tubes were placed by four pediatric surgeons, with 69 of these utilizing temporary sutures and 57 utilizing subcutaneous sutures. Higher rates of stitch abscess, cellulitis, and ED visits were noted with subcutaneous sutures (7% vs. 4.3%, 10.5% vs. 5.8%, and 10.5% vs. 2.9%), while higher rates of tube dislodgement and granulation tissue were noted with temporary sutures (10.1% vs. 5.3% and 24.6% vs. 12.2%). Overall, subcutaneous polydioxanone (PDS) fixation had the lowest complication rate.

Gastric fixation with subcutaneous PDS during pediatric laparoscopic gastrostomy tube placement had the lowest overall short-term complication rates at our institution, suggesting this may be the preferred choice of fixation.