P1141 PERSISTENCE OF GASTROCUTANEOUS FISTULA AFTER REMOVAL OF GASTROSTOMY TUBE OR BUTTON IN CHILDREN: PREVALENCE AND ASSOCIATED FACTORS

Abstract

Introduction: The aim of this study was 1) to determine the prevalence of gastrocutaneous fistula after removal of gastrostomy in children 2) to search for associated risk factors. Methods: Charts of children in whom gastrostomy was removed between January 1992 and December 2002 were reviewed retrospectively. Persistent gastrocutaneous fistula was defined as the absence of closure of gastrostomy 1 month after removal of material. Factors that could influence spontaneous closure including age, underlying disease, nutritional status, type of gastrostomy, replacement by a button, abdominal wall thickness, duration of time that gastrostomy tube and/or button were maintained in place, complications related to the presence of gastrostomy (infection, presence of granulation tissue) were studied. Results: Among 312 patients undergoing gastrostomy during the study period, 44 patients aged between 1 day and 14 years (median age: 20 months; percutaneous endoscopic gastrostomy, n=28; surgical gastrostomy, n=16) fulfilling the inclusion criteria were included. Mean time of spontaneous closure was 6±7 days. Persistent gastrocutaneous fistula was found in 11 patients (25%) and required surgical closure in 7/11 patients. The duration of time that gastrostomy was maintained in place was significantly longer in patients with gastrocutaneous fistula compared to patients with no fistula (39±19 versus 22±23 months respectively; p=0.03). No other significant association was found between the characteristics of patients, the type of gastrostomy and the time required for spontaneous closure. Conclusion: Persistent gastrocutaneous fistula appears frequent after removal of gastrostomy in children. Surgical closure should only be considered when gastrostomy does not close spontaneously beyond 1 month after removal of material.