B. Carr1, C. Sutherland1, K. Biddle1, M. Jarboe1, S. Gadepalli1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction:
Gastrostomy tube placement is a common procedure which can involve various techniques and types of tubes, and risks a number of common complications. In an effort to standardize practice at our institution, we retrospectively evaluated complications including early dislodgement requiring operative repair, leaks, and granulation tissue to determine the ideal technique and tube type.
Methods:
A retrospective cohort study (June, 2008 – June, 2014) evaluating children(<18) receiving gastrostomy tubes was completed. We recorded demographic data, tube type, placement technique, and postoperative complications within 120 days, comparing the groups before and after 2012. Tube types included long tubes, low-profile tubes (buttons) and standard PEG tubes. Techniques were categorized as standard pull-type technique for PEGs, “push” technique using transabdominal sutures or fasteners for anterior apposition of the stomach, and those with fascial sutures securing the stomach wall to the edges of the abdominal fascial defect. Descriptive statistics were analyzed using t-test, chi-square, Kruskal-Wallis and age-adjusted outcomes with p<0.05 considered significant.
Results:
Of the 450 patients, 52% had long tubes, 26.7% buttons, and 21.3% PEGs, placed with fascial (54.4%), push (24.9%,) or pull (20.7%) techniques. Complications were lowest for the push technique and for button placement. As the number of buttons placed using push technique increased (6% to 68%), we saw a concomitant drop in dislodgements (6.8%v1.8%,p=0.03) and leaks (32.3%v20.8%,p=0.02), without any increase in granulation (51.3%v52%,p=0.9).
Conclusion:
Push technique to place button tubes was associated with the lowest complication rate and we recommend standardization to this approach and tube type.
