T. Kuriakose1, F. D. Arias1, Y. Lee1,2 1Rutgers Robert Wood Johnson Medical School,Division Of Pediatric Surgery, Department Of Surgery,Piscataway, NJ, USA 2Robert Wood Johnson University Hospital,Bristol-Myers Squibb Children’s Hospital,New Brunswick, NJ, USA
Introduction: Gastrostomy tubes can be inserted using percutaneous endoscopic technique (PEG), laparoscopic or open. The choice of technique is usually determined by surgeon preference. The fear of complication has deterred many pediatric surgeons from performing PEG in young children. Evidence supporting this claim is scant. We hypothesize that PEG can be safely performed in children.
Methods: We conducted a retrospective review of gastrostomy tube insertion in children age 0-21 at an academic medical center from 1/2014 to 4/2018. Gastrostomy tube insertions were identified by CPT codes. Patients were excluded from analysis if they had prior gastrostomy tube, concurrent major surgery or incomplete records. Data collected included operative time, length of stay from procedure to discharge, rates of conversion to a different technique and complication. Complications are defined as return to emergency department (ED), return to operating room (OR), and hospital readmission within 30 days of procedure.
Results: 116 gastrostomy tube patients were identified, and after applying exclusion criteria, 83 were analyzed. There were 30 girls and 53 boys. 49 of these patients were younger than 2 years of age. 56 patients underwent PEG placement. The average operative time was 37.1 minutes (95% CI: 31.3-42.8). Average length of stay was 4.67 days (95% CI: 3.19-6.15). 5.4% (3/56) of PEG procedures required conversion to laparoscopic or open. 7.1% (4/56) of these patients visited the ED within 30 days of procedure; 3 of whom required tube replacement. 1.8% (1/56) of these patients had a GI-related readmission (erythema at tube site). 10 patients underwent laparoscopic gastrostomy tube placement. The average operative time was 88.8 minutes (95% CI: 66.9-110.7). The average length of stay was 4.1 days (95% CI: 2.24-5.96). 10% (1/10) required conversion to open. None of laparoscopic group had an ED visit or a GI-related readmission within 30 days of procedure. 17 patients underwent open gastrostomy tube placement. The average operative time was 76.7 minutes (95% CI: 55.1-98.3). The average length of stay was 9.06 days (95% CI: 0.37-17.75). 5.9% (1/17) of these patients visited the ED within 30 days of procedure; none required gastrostomy tube replacement. 5.9% (1/17) of these patients had a GI-related readmission (erythema and drainage at tube site) within 30 days of procedure. In our study, only one case returned to OR within the study period for gastrostomy tube revision, and the initial technique use was open.
Conclusion: PEG is associated with the shortest operative time of all procedures. Laparoscopic gastrostomy tube insertion is associated with longest operative time but the shortest postoperative length of stay. There is no complication identified in the laparoscopic group. Open gastrostomy tube insertion is associated with the longest postoperative length of stay, and a comparable rate of complication as compared to PEG.