Postoperative complications after laparoscopic gastrostomy tube placement: Does gastropexy suture technique matter?

To compare postoperative complications among three common gastropexy techniques used in pediatric patients undergoing laparoscopic gastrostomy tube (GT) placement.

Patients ≤7 years of age who underwent laparoscopic GT placement at our institution between 1/2019-1/2025 were retrospectively reviewed. Patients were categorized and compared based on gastropexy technique: external transabdominal, buried transabdominal, or laparoscopic-assisted trans-fascial. The primary outcome was 30-day surgical site infection. Secondary outcomes included other postoperative complications, such as tube dislodgement, granulation tissue, reoperations, and mortality.

A total of 916 patients were analyzed: 86 (9.4%) external transabdominal sutures, 254 (27.7%) buried transabdominal, and 576 (62.9%) laparoscopic-assisted trans-fascial. Median age was 11 months [IQR 5.0, 24.0] and weight was 8.01 kg [IQR 5.53, 11.20]. There was no statistically significant difference in demographics across the three groups. There were no statistically significant differences among the external transabdominal, buried transabdominal and laparoscopic-assisted trans-fascial cohorts in 30-day surgical site infections (2.3% vs. 3.1% vs. 4.9%, p = 0.455), emergency department visits (11.6% vs. 12.2% vs. 13.5%, p = 0.805), or hospital readmissions (2.3% vs. 2.0% vs. 4.5%, p = 0.189). Similarly, there was no difference in 90-day outcomes among the cohorts: GT dislodgement (12.8% vs. 7.1% vs. 6.6%, p = 0.119) and GT site granulation tissue (60.5% vs. 54.3% vs. 57.1%, p = 0.572). On regression analysis, there were no factors associated with an increased risk for SSI.

Postoperative complications did not differ across three gastropexy techniques. Granulation tissue formation was the most frequent complication, whereas SSI occurred less commonly and was not independently associated with gastropexy technique or suture type. Gastropexy method may be selected based on surgeon preference without increasing the risk of adverse postoperative outcomes following laparoscopic gastrostomy tube placement.