Practice Variations in Pediatric Gastrostomy Tube Suture Fixation After Laparoscopic Placement: Does it Matter?
*Meagan Rosenberg, *Nicole Boone, *Aixa Perez Coulter, *Victoria Pepper, Gregory Banever, David B. Tashjian, Kevin Moriarty, Michael V. Tirabassi
Baystate Medical Center, Springfield, MA, United States.
Background: Laparoscopic gastrostomy tube (GT) placement is a common procedure to provide enteral access in pediatric patients with feeding difficulties. There are several suture fixation methods (FMs) described to secure a freshly placed GT at skin level. The goal of this study is to compare postoperative complications between the various FMs utilized at our institution to secure the tube at skin level.
Study Design: A retrospective cohort study was conducted of 81 pediatric patients undergoing laparoscopic GT placement from 10/1/2010 to 10/1/2021 at a single institution. Demographic data and patient characteristics were obtained. Suture fixation of the GT at skin level included suture fixation to skin only, sutures fixated through full thickness of the abdominal wall and stomach serosa, or no suture fixation. Stomach fixation method was not controlled for. FM was determined by operative report review and evaluated in relation to 90-day post-operative complications including GT dislodgement, skin breakdown, superficial infection, granulation tissue formation, and return to the emergency department (ED) within 30 days. Differences were assessed using Student's t and Mann-Whitney U tests, along with Chi-squared and Fisher's exact tests. Statistical significance was defined as ?=0.05.
Results: A total of 81 patients were included. Average age was 3.8 years (range 0-16 years), and 42% were female. 27 (33.3%) had skin fixation, 9 (11.1%) had full thickness sutures, and 45 (55.6%) had no suture fixation. There were 76 complications with 14 patients presenting with multiple complications. Granulation tissue was the most common complication (55, 72.3%), followed by superficial cellulitis (15, 19.7%), skin breakdown (4, 5.3%), and malfunction (2, 2.6%) (Table 1). A significant correlation was found between skin breakdown and full thickness suture fixation. Skin fixation only had no instances of skin breakdown, full thickness sutures had 2 (22.2%) and no button fixation also had 2 (4.4%) (p=0.03). There was a trend towards lower incidence of post-operative granulation tissue formation in patients with skin fixation of the button but did not reach significance (p=0.07). In total, 18 patients presented to the ED within 30 days post-operatively for GT related causes with no correlation based on FM. There were no dislodgements prior to 6 weeks post-operatively.
Conclusions: Despite the lack of suture fixation in greater than 50% of patients, there were no tube dislodgements regardless of fixation method.
Gastrostomy tube complications by tube fixation technique.
| Superficial Infection | GT Malfunction | Skin Breakdown | Granulation Tissue Formation | ED Return Within 30 Days | Percentage of Total Complications (n=76) | |
| Skin Fixation (n=27), n (%) | 5 (18.5%) | 1 (3.7%) | 0 (0.0%) | 14 (51.9%) | 5 (18.5%) | 26.3% |
| Full Thickness Fixation (n=9), n (%) | 2 (22.2%) | 1 (11.1%) | 2 (22.2%) | 6 (66.7%) | 2 (22.2%) | 14.5% |
| No Suture Fixation (n=45), n (%) | 8 (17.8%) | 0 (0.0%) | 2 (4.4%) | 35 (77.8%) | 11 (24.4%) | 59.2% |
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