The Abdominal Wall Factor: Impact of Surgical Technique in Feeding Access in the Obese Population

Abstract

INTRODUCTION: Surgical feeding access is necessary in long-term care of patients. Although high complication rates have been documented, modification of operative technique to minimize complication has not been described. We sought to document complication rate of surgical feeding access and identify contributing factors. We hypothesized that in obese patients, laparoscopic gastrostomy tubes (LapG) would confer fewer complications than percutaneous gastrostomy tubes (PEG). METHODS: We conducted a retrospective review of all surgical feeding access cases performed by the ACS service from September 1, 2012, to June 30, 2021. Patient demographics, hospitalization metrics, and outcomes were compared. RESULTS: Feeding access accounted for 14% of cases performed by the ACS service and represented 21% of 30-day mortalities. There were 133 complications associated with these procedures, with no difference between trauma and emergency general surgery populations (6.8% vs 5.7%, p = 0.44). Patients with a BMI >30 kg/m2 had a higher incidence of complications including tube migration requiring operation (4.6% vs 2.5%, p = 0.03). This association held true in PEG patients (4.8% vs 2.2%, p = 0.03), but not in LapG patients (2.4% vs 2.6%, p = 0.87). CONCLUSION: Complications from feeding access has been studied, but this is the first to determine thresholds for changes in operative approach. ACS surgeons should consider LapG over PEG to minimize complication risk in patients with BMI >30 kg/m2. We must tailor our operative technique to the patient populations we care for instead of using a “one-size fits all” approach. If surgeons are tasked feeding access procedures to facilitate patient throughput, we must mitigate potential complications instead of accepting their inevitability.