Assessing Clinical Outcomes Post Modified Laparoscopic Gastrostomy in Children: a Case Control Study

BackgroundGastrostomy has become a common surgical procedure within the pediatric population with feeding difficulties and nutritional issues. In the aims of improving clinical outcomes, this research targets to compare the rate of complications of two different laparoscopic techniques of a gastrostomy button placement in a pediatric population: A combination of modified U-stitches and seldinger technique laparoscopic gastrostomy (MLG) versus the standard laparoscopic gastrostomy (LG).MethodsEighty-nine children were recruited for this retrospective case control study that assesses the surgical outcomes of a novel MLG, being the cases to the standard LG in children which are the controls. The main outcome measure is the rate of postoperative complications encompassing dislodgement of gastrostomy button, leak around button, local infection, and development of granulation tissue post-surgery which is compared between the two population groups.ResultsThe p-value of the study was shown to be 0.03 proving a statistical significance between the complication rates. ConclusionAs a result, the modified U-stitches laparoscopic gastrostomy has a lower rate of complications in comparison to the standard laparoscopic gastrostomy making it a better technique for gastrostomy placement in children.

Use of a Laparoscopic Witzel Gastrostomy Without Gastropexy in Bariatric and General Surgery

Background Gastrostomy placement is the preferred means of long-term enteral feeding for patients who cannot eat by mouth. During laparoscopic gastrostomy, it is standard to perform gastropexy, apposing visceral and parietal peritoneum. In some settings, due to altered anatomy from prior surgery, direct apposition of the stomach to the abdominal wall is not possible. This study reports a series of cases where laparoscopic gastrostomy was performed via a Witzel approach without gastropexy. Methods A retrospective chart review was performed of all patients at a tertiary academic medical center who underwent Witzel gastrostomy without gastropexy over a 3-year period. In each case, an 18-French tube was placed into the fundus of the stomach and secured with a purse-string suture. A 5-cm serosalized Witzel tunnel was created around the tube using running silk suture. No gastropexy was performed. Results Six patients underwent 7 Witzel gastrostomy procedures. In three cases, patients had undergone prior major upper abdominal surgery where adhesive disease prevented gastropexy. In the other four cases, the patients had undergone prior gastric bypass with antecolic antegastric position of the roux limb. No patient suffered leak of gastric contents into the peritoneum, and there were no postoperative complications or mortality related to the gastrostomy. Conclusion In cases where enteral access is necessary, and where the stomach cannot reach the anterior abdominal wall for gastropexy due to prior surgeries, a Witzel gastrostomy without gastropexy is a safe option which resulted in no morbidity or mortality in our series.