C. A. Mason1, D. E. Skarda1, B. T. Bucher1 1University Of Utah School Of Medicine,Division Of Pediatric Surgery, Department Of Surgery,Salt Lake City, UT, USA
Introduction: Historically, gastrostomy placement involved securing the stomach to the anterior abdominal wall in a Stamm-like fashion. With the advent of laparoscopic gastrostomy (LAG), several methods have been described to mimic the Stamm technique which include the use of temporary or subcutaneous transfascial abdominal wall sutures. Our goal is to determine if a particular suture technique results in an increased risk for the development of postoperative complications or resource utilization.
Methods: A retrospective cohort analysis was performed for patients less than 18 years of age who underwent LAG placement surgery at a tertiary Children’s Hospital between 2012 and 2016. Children were identified based on Current Procedural Terminology Code for Laparoscopic Gastrostomy. The medical records were reviewed and children were grouped according to suture techniques for LAG placement: subcutaneous absorbable or temporary (externally-fixed or none) sutures. Postoperative outcomes at 30 days were defined as major complications (tube dislodgement, unplanned reoperation, readmission) and minor complications (stitch abscess, surgical site infection, emergency department visit). The Chi Square Test was used to determine if an association existed between the suture techniques and 30-day postoperative complications.
Results: We identified 682 pediatric patients (52% female) who underwent LAG placement during the study period. The mean age of our cohort was 3 years, the most common comorbidity that necessitated the use of a feeding tube was failure to thrive (44%), and 10% of our patient population had previously undergone GI surgery. Of the patients in our cohort, 301 (44%) had subcutaneous sutures placed and 381 (56%) had temporary sutures placed. The overall rate of major and minor complications was 8.3% and 22%, respectively. We observed a significant difference in the occurrence of major postoperative complications between the subcutaneous and temporary suture techniques (11% vs 6.3%, p=0.04). However, there was no statistical significance among the individual major complications including tube dislodgment, reoperation, and readmission. (Table) Likewise, there was no significant difference in the development of minor complications between subcutaneous and temporary suture techniques.
Conclusion: Children undergoing subcutaneous absorbable suture placement during laparoscopic gastrostomy (LAG) are at an increased risk for developing a major complication (accidental tube dislodgment, unplanned reoperation, or hospital readmission) within 30 days of the procedure. The rate of 30-day postoperative minor complications was similar in children undergoing either subcutaneous or temporary suture placement during LAG.
