Modified open technique for laparoscopic gastrostomy tube placement results in more leakage post operatively than Seldinger technique

• Published in: The American journal of surgery Vol. 218; no. 4; pp. 722 - 725
• Main Authors: Kvasnovsky, Charlotte L., Rich, Barrie S., Denning, Naomi-Liza, Kallis, Michelle P., Lipskar, Aaron M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2019; Elsevier Limited
• Subjects: Antibiotics; Child; Child, Preschool; Children; Cohort Studies; Complications; Enteral Nutrition - adverse effects; Female; Gastrostomy - adverse effects; Gastrostomy - methods; Granulation; Humans; Hypergranulation tissue; Infant; Infections; Intubation, Gastrointestinal - adverse effects; Intubation, Gastrointestinal - methods; Laparoscopic gastrostomy; Laparoscopy; Laparoscopy - adverse effects; Leakage; Male; Medical personnel; Morbidity; Ostomy; Patients; Pediatrics; Placement; Postoperative Complications - epidemiology; Stomach; Surgeons; Surgery; Suture technique; Temporary suture; Temporary suture; Pediatrics; Laparoscopic gastrostomy; Hypergranulation tissue; Complications; Suture technique
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.07.023

Laparoscopic gastrostomy tube (GT) placement is a common procedure and frequent cause of morbidity. Some surgeons perform a Seldinger technique (ST), while others perform a modified open technique (MOT). We hypothesized that the modified open technique would result in more complications.
A prospective study of primary GT placed 12/2016-06/2018, ensuring at least 6 months follow up. We assessed any episode of granulation tissue, troublesome leaking, tube dislodgment, and infection requiring antibiotic or drainage.
92 GT were placed, with 56 were placed as modified open (60.9%). 34 children (37.0%) developed granulation tissue, 18 children (19.6%) experienced tube dislodgment, and 6 children (6.5%) developed a site infection, with no difference depending on technique (P = 0.56, 0.29, and 0.76, respectively). Following ST, 2 children developed leakage (5.6%), whereas 15 children (26.8%) had leakage following the MOT (P = 0.01).
MOT resulted in significantly more leaks. Other complications were similar between groups. Surgeons choosing MOT should be mindful of the size of gastrotomy at time of surgery, as this may result in increased complications.
•Modified open and Seldinger techniques have similar rates of most complications.•Gastrostomy tube by modified open technique results in more leakage post operatively.•Leakage following gastrostomy tube can result in multiple outpatient visits.