Elsevier

Journal of Pediatric Surgery

Volume 39, Issue 9, September 2004, Pages 1390-1395
Journal of Pediatric Surgery

Gastrostomy revision: Incidence and indications

https://doi.org/10.1016/j.jpedsurg.2004.05.018Get rights and content

Abstract

Background/purpose

Although quite reliable, gastrostomy may require revision. However, there are no reports in the literature specifically delineating identifiable risk factors or circumstances that lead to gastrostomy revision in children with gastrostomy. The purpose of this report was to determine the rate of revision and correlate any factors that may lead to revision.

Methods

A retrospective chart review was performed on 1,042 children who underwent gastrostomy at The Children’s Hospital, Denver, Colorado, between 1992 and 2002. Charts of children who underwent gastrostomy were reviewed for pertinent clinical factors and compared with those who required gastrostomy revision.

Results

Of the 1,042 children, who had gastrostomies, 67 revisions were required in 61 children (6%). Of the many possible factors that could have had an influence on the revision rate, only fundoplication, percutaneous endoscopic gastrostomy (PEG), migration of the gastrostomy site, and time correlated with the need for gastrostomy revision.

Conclusions

Parents should be made aware that there is a 6% chance that their child’s gastrostomy may need revision and that the need for revision may increase with PEG, initial construction before 18 months of age, and the advancing age of the gastrostomy. Surgeons should avoid placing the gastrostomy near the costal margin, making a large gastrostomy exit tract through the abdominal wall and inserting a gastrostomy into the nutritionally depleted pulmonary stressed neurologically challenged child without first attempting to improve the child’s nutritional status.

Section snippets

Materials and methods

A retrospective chart review was performed on the charts of children who underwent gastrostomy at The Children’s Hospital, Denver, Colorado, between 1992 and 2002. Charts of children who had a gastrostomy revision were analyzed for age at initial surgery, disease precipitating gastrostomy insertion (neurologic, reflux, nonreflux gastrointestinal, renal), type of surgery (open, percutaneous endoscopic gastrostomy [PEG], laparoscopic, laparoscopic assisted), indication for revision, time elapsed

Results

There were 1,042 children who had gastrostomy performed and who had sufficient data and follow-up for inclusion in this study. The indications for revision and the results of this study are tabulated in Table 1, Table 2, Table 3, Table 4, Table 5. Of the 1,042 gastrostomies performed, 605 were still actively in use at the time of data collection; 437 were no longer needed and either closed spontaneously after tube removal or closed surgically. Follow-up of these 1,042 children with

Discussion

Historically, gastrostomy has been associated with a myriad of complications ranging from minor skin irritation to death.1, 2, 3, 4, 5, 6, 7, 8 Clinical experience and technical modification have virtually eliminated death, hemorrhage, esophageal perforation, and other dire complications.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 Improvements in gastrostomy appliances17, 18 have made complications, such as obstruction of the duodenum by a long tube sliding from the stomach into the

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