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DOI: 10.1055/s-0029-1238316
© Georg Thieme Verlag KG Stuttgart · New York
Continuous Double U-stitch Gastrostomy in Children
Publication History
received July 01, 2009
accepted after revision July 18, 2009
Publication Date:
14 October 2009 (online)
![](https://www.thieme-connect.de/media/ejps/201001/lookinside/thumbnails/10.1055-s-0029-1238316-1.jpg)
Abstract
Background: In children, a gastrostomy button was placed as the initial feeding tube, using laparoscopy and a modified surgical technique. The aim of this study was to test the hypothesis that a new surgical procedure developed at our institution would result in fewer postoperative complications.
Patients and methods: Sixty-two consecutive children with nutritional problems underwent a video-assisted gastrostomy operation (VAG). The technique requires the use of a 2 or 3 mm laparoscope optic and a 5 mm trocar placed at the exit site chosen for the gastrostomy. A continuous double U-stitch absorbable suture created a purse string suture around the gastrostoma on the stomach and fixated the stomach to the abdominal wall. For comparison, we used a control group of 68 children with nutritional problems operated on with our previously published VAG technique. After surgery, the children were followed up at one and six months and all complications were documented according to a protocol.
Results: The two groups of children were comparable with regard to their demographic data. There were no serious intra-operative or postoperative intra-abdominal complications requiring reoperation. There was a significantly lower incidence of the minor complication of granuloma around the gastrostoma in the study group compared with the control group.
Conclusion: This variation of the surgical technique is simple and effective. It allows primary placement of a gastrostomy button that is functionally and cosmetically comparable to a gastrostomy tube surgically placed by other methods. In this study, the patients had fewer postoperative problems than the control group.
Key words
gastrostomy - laparoscopy - child
References
- 1 Albertsson-Wikland K, Karlberg J. Natural growth in children born small for gestational age with and without catchup growth. Acta Paediatr Suppl. 1994; 399 64-70
- 2 Andersson L, Mikaelsson C, Arnbjornsson E. et al . Laparoscopy aided gastrostomy in children. Ann Chir Gynaecol. 1997; 86 19-22
- 3 Aprahamian CJ, Morgan TL, Harmon CM. et al . U-stitch laparoscopic gastrostomy technique has a low rate of complications and allows primary button placement: experience with 461 pediatric procedures. J Laparoendosc Adv Surg Tech A. 2006; 16 643-649
- 4 Arnbjornsson E, Backman T, Morse H. et al . Complications of video-assisted gastrostomy in children with malignancies or neurological diseases. Acta Paediatr. 2006; 95 467-470
- 5 Arnbjornsson E, Larsson LT, Lindhagen T. Complications of laparoscopy-aided gastrostomies in pediatric practice. J Pediatr Surg. 1999; 34 1843-1846
- 6 Backman T, Arnbjornsson E, Berglund Y. et al . Video-assisted gastrostomy in infants less than 1 year. Pediatr Surg Int. 2006; 22 243-246
- 7 Backman T, Berglund Y, Sjovie H. et al . Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt. Pediatr Surg Int. 2007; 23 665-668
- 8 Conlon SJ, Janik TA, Janik JS. et al . Gastrostomy revision: incidence and indications. J Pediatr Surg. 2004; 39 1390-1395
- 9 Fonkalsrud EW, Ashcraft KW, Coran AG. et al . Surgical treatment of gastroesophageal reflux in children: A combined hospital study of 7467 patients. Pediatrics. 1998; 101 419-422
- 10 Gauderer MWL. Percutaneous endoscopic gastrostomy: A 10 year experience with 220 children. J Pediatr Surg. 1991; 26 288-294
- 11 Khattak IU, Kimber C, Kiely EM. et al . Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome. J Pediatr Surg. 1998; 33 67-72
- 12 Kimber CP, Khattak IU, Kiely EM. et al . Peritonitis following percutaneous gastrostomy in children: Management guidelines. Aust N Z J Surg. 1998; 68 268-270
- 13 Kubiak R, Wilcox DT, Spitz L. Gastrojejunal fistula after insertion of percutaneous endoscopic gastrostomy. J Pediatr Surg. 1999; 34 1287-1288
- 14 Liou TG, Adler FR, Fitzsimmons SC. et al . Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol. 2001; 153 345-352
- 15 Noren E, Gunnarsdottir A, Hanseus K. et al . Laparoscopic gastrostomy in children with congenital heart disease. J Laparoendosc Adv Surg Tech A. 2007; 17 483-489
- 16 Patwardhan N, McHugh K, Drake D. et al . Gastroenteric fistula complicating percutaneous endoscopic gastrostomy. J Pediatr Surg. 2004; 39 561-564
- 17 Rothenberg SS, Bealer JF, Chang JH. Primary laparoscopic placement of gastrostomy buttons for feeding tubes. A safer and simpler technique. Surg Endosc. 1999; 13 995-997
Correspondence
Dr. Torbjörn Backman
University Hospital
Department of Pediatric Surgery
22185 Lund
Sweden
Phone: +46/461/71000
Fax: +46/461/72299
Email: torbjorn.backman@skane.se