Outcomes After Laparoscopic Gastrostomy Suture Techniques in Children

Abstract

Background: There are various suture techniques used during laparoscopic gastrostomy to secure the stomach to the anterior abdominal wall. However, it remains unclear whether temporary fixation or subcutaneous absorbable sutures predispose pediatric patients to fewer postoperative complications. Our goal was to determine if a particular suture technique resulted in an increased risk for the development of postoperative complications.Materials and methods: A retrospective cohort analysis was performed for patients less than 18 y of age who underwent laparoscopic gastrostomy at a tertiary Children's Hospital between 2012 and 2016. Children were grouped according to suture techniques for laparoscopic gastrostomy placement: temporary sutures or subcutaneous absorbable sutures.Postoperative outcomes at 30 d were defined as major complications (tube dislodgement, unplanned reoperation, readmission) and minor complications (stitch abscess, surgical site infection, emergency department visit). The chi squared test was used to determine if an association existed between the suture techniques and 30 d postoperative complications.Results: We identified 682 pediatric patients who underwent laparoscopic gastrostomy. There were 301 (44%) patients with subcutaneous sutures placed and 381 (56%) with temporary sutures placed. The overall rate of major and minor complications was 8.3% and 22%, respectively. We observed a significant difference in the occurrence of major postoperative complications between the subcutaneous and temporary suture techniques (11% versus 6.3%, P ¼ 0.029). There was no significant difference in the development of minor complications between subcutaneous and temporary suture techniques.Conclusions: Children who receive subcutaneous sutures during laparoscopic gastrostomy are at an increased risk for developing a major postoperative complication.

Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants

“…The postoperative outcomes at 30 days showed no significant differences in the development of minor complications including surgical site infections between SC and temporary suture techniques. 22…”

“…The surgical methods used for gastrostomy differ across various centers. 18 19 20 21 22 23 24 However, with all techniques, a foreign body is left in the wound with either stitches or T-fasteners used to anchor the stomach to the anterior abdominal wall. In addition, the infant's clinical situation, periods of cardiac insufficiency, and various phases of treatment with cytostatic drugs may influence healing.…”

“…Thus, the results of our study can be used as a benchmark for further attempts in improving the postoperative results after LAG tube placement. This can be implemented by using some of the suggestions for improvement already found in the literature 20 22 23 27 28 29 30 31 32 or by new interventions.…”

“…The postoperative outcomes at 30 days showed no significant differences in the development of minor complications including surgical site infections between SC and temporary suture techniques. 22 The use of U-stitch LG 4 for the placement of balloon gastrostomy for pediatric patients, in which the stay sutures are placed in SC tissue, may lead to suture knot abscess formation. 23 Twenty-seven consecutive patients were evaluated, whereby the stay suture knots were positioned within the gastrostomy tract instead of the SC tissue in an attempt to minimize suture knot abscess formation.…”

Laparoscopic Gastrostomy Placement in Children Has Few Major, but Many Minor Early Complications

“…Over the years, several attempts have been made to improve the LAPG technique and to avoid both major and minor complications. 13,32 Although studies suggest fewer compli-cations after LAPG compared with PEG, no randomized controlled trials have been performed and there is no consensus on preferred technique. Gastrostomy insertion, both LAPG and PEG, remains a procedure with a significant risk for complications, and physicians should take into consideration the patients' comorbidity and procedure-related risk when choosing technique.…”