Gastrostomy In Children Research Articles

Correlation between the preoperative state of nutrition and the frequency of postoperative problems after video-assisted gastrostomy in children.

Gastrostomy operations are performed on children referred to the pediatric surgical clinic without being influenced by the patient’s state of nutrition. This has been motivated by the idea that a gastrostomy would enable a fast and secure improvement in this regard. The question arises whether an improvement in the preoperative nutritional status would reduce the number of postoperative complications. The aim of the study was to test the hypothesis that the frequency of postoperative complications after a video-assisted gastrostomy is correlated to the child’s preoperative state of nutrition. Fifty consecutive children with severe nutritional problems underwent a video-assisted gastrostomy operation where gastrostomy buttons were placed as the initial surgical feeding tube. At the time of the operation, the children’s nutritional parameters were registered routinely. After the operation, the children were followed up prospectively for six months and all complications were documented according to a protocol. The children were ranked according to the severity and frequency of postoperative complications and problems. Correlation to nutritional parameters was calculated. The children did not present with any serious postoperative intra-abdominal complications. There was a significant correlation between the frequency of minor complications and the child’s state of nutrition, measured as the number of standard deviations from normal length and weight as well as phosphate, magnesium, and iron levels in the blood. This study revealed a significant correlation between the patients’ state of nutrition and the postoperative complications during the first postoperative six months. Thus, the findings support a routine of nutritional evaluation prior to performing a gastrostomy operation.

Perceptions of caregivers following percutaneous endoscopic gastrostomy in children with congenitally malformed hearts

While the usefulness of percutaneous endoscopic gastrostomy is clearly established in the nutritional support of children with neurodisability, the role in substituting for prolonged nasogastric feeding in children with congenitally malformed hearts is a relatively recent development. There are no previously published experiences of the perceptions of parents or those providing care following the insertion of percutaneous endoscopic gastrostomy in such children. Descriptive qualitative survey of parental perceptions using a semi-structured questionnaire. We obtained completed 27 point semi-structured questionnaires from 38 providers of care for children with congenitally malformed hearts. Time taken to feed their children reduced significantly after the percutaneous endoscopic gastrostomy, from 30 to 60 minutes previously to 15 minutes subsequently. The frequency of feeding also reduced significantly, from 6 times a day to 4 to 5 times a day. Those providing care perceived significant reductions in pre-procedural symptoms, the ease of administering medications, and noted an enhanced level of happiness in their children. Of those providing care, 97% were highly satisfied with the procedure, with 15 parents (40%) wishing that the operation was done earlier, while the remainder considered it had been done at the appropriate time. Those caring for children with congenitally malformed hearts perceive significant improvements in the symptoms, wellbeing, and ease of administering medication for their children after percutaneous endoscopic gastrostomy. Of the group, 97% regarded the procedure as the appropriate means of assisting nutritional support.

Microlaparoscopic-Assisted Gastrostomy in Children: Early Experiences with Our Technique

The aim of this prospective study was to evaluate the feasibility and safety of a new technique for microlaparoscopic-assisted gastrostomy (MAG) in children and infants by using a 1.9-mm scope only. In this paper, we report our early experiences with this method. In a prospective study, MAG was performed on 12 children (7 boys and 5 girls) after a primary percutaneous endoscopic gastrostomy procedure was considered not feasible or unsafe. The median patient age at the time of surgery was 1.2 years (range, 4 months to 4 years). A 1.7- or 1.9-mm 0-degree scope was introduced at the umbilicus. A 5-mm port was placed over the stomach at the designated site for the tube placement. The stomach was grasped and exteriorized. The gastrostomy was opened, and a balloon gastrostomy tube was placed. In 12 children, the procedure was successfully completed without conversions. Mean operative time was 19 minutes (range, 13-35). No intraoperative complications occurred. Feeds were instituted 5 hours postoperatively and quickly advanced the following day in 11 of 12 children. The procedure may be performed as day surgery. In our opinion, MAG is a feasible, safe procedure in children. Technically, it is a simple method, particularly in cases where percutaneous tube placement is not feasible. It combines the advantages of microlaparoscopy and open surgery. It is easy to perform in children and allows a primary gastrostomy tube placement. Parents and nursing staff also seem satisfied.

Laparoendoscopic Gastrostomy Tube Placement: Our All-in-One Technique

Gastrostomy tube placement may be performed in numerous ways: percutaneous endoscopic gastrostomy (PEG), laparoscopic PEG, and laparoscopic gastrostomy tube placement. In this paper, we propose a new technique of laparoendoscopic gastrostomy tube (LEGT) placement, using a three-suture technique to pexy the stomach to the abdominal wall. This paper outlines the LEGT technique and its benefits over previously reported techniques. Five children were included in this study during 2007. Their ages ranged from 15 months to 14 years. Under general anesthesia, a gastroscope was placed in the stomach and laparoscopic visualization was obtained through a 5-mm umbilical port. Two small incisions were made transabdominally for working instruments. Using laparoscopic visualization, three sutures were placed around a proposed gastrostomy site in the stomach. These sutures were pulled externally, using a GraNee needle (R-Med, Inc., Oregon, OH). Under visualization by a gastroscope, the gastrostomy button was placed in the center of these three sutures at the proposed gastrostomy tube site. Once the gastrostomy balloon was inflated, the three sutures were pulled taught and tied subcutaneously to pexy the stomach to the abdominal wall. Inspection with the gastroscope and laparoscope ensured proper gastrostomy tube placement. All patients had no complications intra- or postoperatively and at 2 months of follow-up. An optimal cosmetic result was obtained, and there was no need for suture removal or a second procedure. The laparoscopic visualization of the LEGT avoids accidental gastrocolic fistula formation and allows primary placement of the gastrostomy button without need for subsequent procedures. The endoscopic visualization, if the LEGT ensures the gastrostomy tube, is placed within the gastric lumen. Additionally, the three-suture technique gives an optimal fixation of the stomach to the abdominal wall, gives outstanding cosmetic results, avoids accidental disruption of sutures, and has no need for suture removal at a postoperative visit. LEGT thus serves as a one-stop shopping approach for gastrostomy in children.

Buried bumper syndrome after percutaneous endoscopic gastrostomy in children and adolescents

my (PEG) has become the preferred method for enteral feeding in children with prolonged insufficient oral intake [1]. A complication of the PEG is the mi− gration of the internal flange into the gas− tric or abdominal wall, referred to as “buried bumper syndrome” (BBS). The prevalence in adults is 2.0% ± 2.9 % [2, 3]. Among the past 700 children who receiv− ed a PEG under our care, a total of 17 BBS were observed (prevalence 2.4 %). The un− derlying diseases in the children were mental retardation with central dyspha− gia (n = 13), congenital heart disease (n = 3) and inherited metabolic disease (n = 1). This reflects proportionally the general distribution of the PEG indication in pediatric patients [1]. The median age of the BBS patients was 6 years and 9 month (2.0 ± 18.5 years), the median time BBS was found after PEG placement was 19 months (2± 48 months). Nine patients were cared for by their parents, in eight patients a professional caregiver was responsible for the child. In all cases the used feeding tube was a Freka CH 15 model (Fresenius GmbH, Germany). En− doscopic therapy was mostly successful by the push and pull technique (n = 8) (l Fig. 1), or if that failed the gastric mu− cosa was incised by a needle knife or fis− tulotome (n = 2) (l Fig. 2). Whenever clinical signs (internal bumper palpable through the skin), endoscopic findings (flushing or probing the tube impossible), or imaging studies indicated that the flange was located outside the stomach wall the patient was referred for surgery (n = 7). Poor postoperative care without appro− priate regular mobilization is an attribut− ing factor to the development of BBS. Only two pediatric cases with a complete BBS reporting in detail course and ther− apy have been published so far [4]. Mostly incomplete BBS “intragastric buried or extruded tube or button” are observed, which required only a replacement of the device [5]. Children with BBS may present with a number of symptoms: a leaking tube, in− ability to infuse feedings, and in particu− lar an immobile tube. In these cases en− doscopy is indicated to diagnose BBS in a timely fashion. Endoscopic therapy is also often possible in children.

Percutaneous Endoscopic Gastrostomy in Children

Percutaneous endoscopic gastrostomy has been a valuable tool in nutritional rehabilitation since its inception in 1980. Although it was originally described in children, a large sector of the adult population is dependent on it for nutritional support. Percutaneous endoscopic gastrostomy tube insertion is generally a safe procedure. Nevertheless, variable incidence rates of complications have been reported. The present review highlights the up-to-date indications, contraindications and complications of percutaneous endoscopic gastrostomy in children, along with a discussion of issues that need further exploring through future research.

Laparoscopic Gastrostomy in Children with Congenital Heart Disease

The aim of this study was to study the type and frequency of complications and change in weight after a laparoscopic gastrostomy procedure in 31 children with congenital heart disease, comparing patient groups of children with univentricular and biventricular circulation, and with completed and uncompleted cardiac surgery. The method used was that of a retrospective study of all 31 children with congenital heart disease who underwent a laparoscopic gastrostomy at our center from 1995 to 2004. Postoperative complications and body weight changes during follow-up were the main outcome measures used in this study. Minor stoma-related problems were common in both groups. Two severe complications requiring an operative intervention occurred in the univentricular circulation group. Weight was normal at birth, low at the time of the gastrostomy procedure, and did not catch up completely during the follow-up period of a mean of 20 months. There were no significant differences regarding mean weight gain between the groups. The complication rate after the laparoscopic gastrostomy procedure was higher in our patient group, compared to previously studied children with various diseases. Comparisons regarding mean weight gain between the groups showed no significant differences. The mean weight gain was low, suggesting that the energy expenditure in this patient group of children with severe congenital heart disease may be even higher than previously assumed.

P-185B 当院における小児PEGの8例 : 興味深い合併症を来した症例を中心に(腹腔鏡手術, 第44回日本小児外科学会学術集会)

P-185B 当院における小児PEGの8例 : 興味深い合併症を来した症例を中心に(腹腔鏡手術, 第44回日本小児外科学会学術集会)

Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt

The aim of the study was to test the hypothesis that the presence of a ventriculoperitoneal shunt (VPS) influences the frequency of postoperative complications after video-assisted gastrostomy (VAG) in children. When using a power of 80%, a critical value for significance of 5% and an assumed population-based standard deviation of 0.4, it will be required to have a sample size of at least 14 children to show that a difference of 0.6 is significant when using Student's t test for paired samples. Thus, 15 consecutive children with VPSs were included in the present study. All the children had nutritional problems and underwent a VAG operation at a tertiary care university hospital. After the operation, the children were prospectively followed up. Specially trained nurses documented all complications according to a protocol. For the purpose of comparison, we had a control group of neurologically disabled children without VPSs, matched for age and operated with VAG. The children did not present with any serious postoperative intra-abdominal complications or central nervous system infection. There was no significant difference in the frequency of minor complications between the studied group and the control group. This study did not reveal that children with VPSs who undergo a VAG button placement are at high risk for infection and subsequent shunt malfunction. They did not have more postoperative problems than a matched control group of neurologically disabled children.

P-183A Laparoscopy-assisted percutaneous endoscopic gastrostomy in children(Laparoscopic surgery, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-183A Laparoscopy-assisted percutaneous endoscopic gastrostomy in children(Laparoscopic surgery, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

Percutaneous Endoscopic Gastrostomy in Children: A Safe Technique with Major Symptom Relief and High Parental Satisfaction

Percutaneous endoscopic gastrostomy (PEG) is widely used for establishing enteral feeding. The aim of this study was to assess immediate and long-term results after PEG insertion. A total of 121 children were retrospectively reviewed. Median age was 2.4 years (range, 4 months-13.2 years) at the time of PEG insertion. Patient morbidity, indications for PEG, preoperative findings and perioperative complications were registered retrospectively. Parents/caregivers of 85 children were interviewed for long-term results. Perioperative complications were seen in 12%. Twenty-four percent died at a median of 15 months (range, 1.5 months-8 years) after PEG. Eighty-five families were interviewed with a median follow-up time of 5.6 years (range, 1-10 years). A substantial majority (94%) of parents/caregivers reported that the PEG had a positive influence on their child's situation, and 98% would have chosen PEG insertion again. Vomiting/retching improved in 61% of the children, and oral intake enhanced in 43%. Stoma-related complications were frequent (73%). The gastrostomy tube was permanently removed at a median of 3 years (range, 7 months-7.3 years) after PEG placement in 25%. Delayed closure of the gastrocutaneous fistula after gastrostomy removal occurred in 48% of them. Time from insertion to removal was not predictive of delayed closure. PEG is a safe technique for establishing enteral feeding, even in very sick children. Major complications are rare, although most children experience minor stoma-related problems. Parents/caregivers report that the gastrostomy is of great help for themselves and their child.

No increase in gastroesophageal reflux after laparoscopic gastrostomy in children

The objective of the study was to assess the influence of a laparoscopic video-assisted gastrostomy on acid gastroesophageal reflux (GER). A prospective uncontrolled study included 23 neurologically disabled children, from 10 months to 15 years of age, all with severe nutritional problems and in need of a gastrostomy. They all had a history of clinical GER problems including vomiting, choking and chest infections. A 24-h pH monitoring was used for a quantitative assessment of GER the day before surgery and 12+/-3 months (7-22 months) postoperatively. The gastrostomy was placed on the anterior wall of the stomach near the lesser curvature. The main outcome measure was the comparison of the pre- and postoperative 24-h pH monitoring and the reflux index (RI), i.e. the percentage of time with pH below 4. The results showed a non-significant reduction of RI from 6.8+/-4.5 preoperatively to 3.7+/-2.0 postoperatively. We conclude that a gastrostomy using the video-assisted technique and placing the stoma on the anterior wall of the stomach close to the lesser curvature does not cause aggravation of acid reflux.

Complications of video‐assisted gastrostomy in children with malignancies or neurological diseases

Abstract Aim: To test the hypothesis whether the administration of cytostatic drugs close to surgery in children with malignancies influences the rate of postoperative complications. Method: Included in the study were 27 children with malignancies and a control group of 27 neurologically impaired children. All the children had nutritional problems and underwent a video‐assisted gastrostomy (VAG) operation during the period 1997–2002. The children were postoperatively followed up. All complications were documented according to a protocol by a specially trained nurse and correlated to the time elapsed from completion of the last preoperative or the first postoperative cytostatic drug treatment. The complications in the two groups were compared. Results: The children with malignant diseases did not have more postoperative complications of the VAG than those having neurological defects. There was no correlation to complications regarding timing of the operation and administration of cytostatic drugs. Conclusion: This study revealed no aggravated influence of cytostatic drug treatment on early postoperative problems of VAG. The timing of cytostatic drug administration in relation to the surgical intervention did not influence the frequency of postoperative complications.

Complications of video-assisted gastrostomy in children with malignancies or neurological diseases

To test the hypothesis whether the administration of cytostatic drugs close to surgery in children with malignancies influences the rate of postoperative complications. Included in the study were 27 children with malignancies and a control group of 27 neurologically impaired children. All the children had nutritional problems and underwent a video-assisted gastrostomy (VAG) operation during the period 1997-2002. The children were postoperatively followed up. All complications were documented according to a protocol by a specially trained nurse and correlated to the time elapsed from completion of the last preoperative or the first postoperative cytostatic drug treatment. The complications in the two groups were compared. The children with malignant diseases did not have more postoperative complications of the VAG than those having neurological defects. There was no correlation to complications regarding timing of the operation and administration of cytostatic drugs. This study revealed no aggravated influence of cytostatic drug treatment on early postoperative problems of VAG. The timing of cytostatic drug administration in relation to the surgical intervention did not influence the frequency of postoperative complications.

Morbidity and mortality after percutaneous endoscopic gastrostomy in children with neurological disability

Gastrostomy placement has become an integral mechanism for delivering nutritional support to children with severe neurological disability. Its impact on gastroesophageal reflux and mortality remains contentious. We examined the morbidity and long-term mortality of a group of children with severe neurological disability after percutaneous endoscopic gastrostomy (PEG). We retrospectively identified all children with severe neurological disability who had a PEG at the Royal Children's Hospital in Melbourne between 1990 and 1997. Data were obtained from medical records. Ninety-eight children with neurological disability (M:F 1.8:1.0; median age 3.5 years, interquartile range 1.1-8.7 years) had an initial PEG in this period and were able to be followed for 6-14 years. As a group, they were underweight for their age with a Z score at PEG of -3.52 (SD 3.33), but had increased weight-for-age Z scores by 1.05 after a mean period of 6.1 months. Fourteen subsequently required fundoplication for reflux. Mortality rates were 11% after 1 year, 21% after 2 years, 27% after 3 years and 39% after 13 years. Mortality was increased in those children who were older at the time of PEG (P = 0.06). Gastroesophageal reflux, underweight-for-age and gender were not significantly related to mortality. Children with severe neurological dysfunction who require gastrostomy feeding have a substantial long-term mortality, but this may be unrelated to PEG placement.

Does gastrostomy tube feeding in children with cerebral palsy increase the risk of respiratory morbidity?

Background: Children with severe neurological impairment may have significant oral motor dysfunction and are at increased risk of nutritional deficiencies, poor growth, and aspiration pneumonia. Gastrostomy tube feeding is increasingly...

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

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.

Percutaneous endoscopic gastrostomy in children--a 5-year experience.

Percutaneous endoscopic gastrostomy (PEG) has been performed on children since 1979. The indications for a PEG are wide ranging and while there are well-established benefits, it remains a procedure with recognised complications. The goal of this study was to review our experience with this procedure at a South African paediatric tertiary referral hospital over a 5-year period. The objectives were to review PEGs with regard to patient characteristics, indications, anaesthesia time required and complications. The study was a retrospective case record review. A total of 70 PEGs were performed. Patients had a mean age of 4 years and 3 months, and a mean weight of 12.2 kg at the time of performing the procedure. The mean anaesthetic time required for performing a PEG was 27 minutes. Fifty-four PEGs (77%) were performed for inability to swallow, 15 (21%) to improve caloric intake, and 1 (1%) for continuous enteral feeding. There were no deaths, 5 patients had major complications (6%), and 12 patients (17%) needed antireflux surgery subsequent to the placement of a PEG. There is an increasing demand for PEGs at our institution. The indications for a PEG in this series are similar to those reported in other series, although we may be underutilising PEGs to improve caloric intake. Our complication rates compare favourably with those reported in other series. We have, however, identified post-PEG gastrooesophageal reflux disease as a complication we would like to reduce, and suggest a practical approach to do so.

Percutaneous endoscopic gastrostomy in children: 15 cases experience.

For long-term tube feeding in children, percutaneous endoscopic gastrostomy (PEG) has the advantages of a short surgical time, early feeding following surgery, and lower rate of complications. From July 2000 to September 2002, we enrolled fifteen children (mean age: 8.2 years old) who underwent PEG placement for long-term nutritional support. Their underlying diseases included mucopolysaccharidosis (MPS) type II severe form, mitochondrial disease, Ehlers-Danlos syndrome associated with Robin sequence, spinal muscular atrophy (SMA) type II, nesidioblastosis, neurofibromatosis and other neurological disorders. We assessed the complications and outcome in these patients after PEG placement. There were no difficulties in PEG tube-feeding after procedure. One patient had a wound infection at the insertion site which required parenteral antibiotic therapy. Symptomatic gastroesophageal reflux (GER) occurred in two patients and was controlled with medication. One patient developed a gastrocutaneous fistula, requiring surgical removal of the PEG tube. One patient underwent laparoscopic gastrojejunostomy and Nissen fundoplication for persistent vomiting. Two patients with mitochondrial disease expired. The other eleven devices have continued to function on follow-up. Placement of a PEG is a simple, feasible procedure for children with swallowing difficulty who require long-term nutritional support. Although complications may sometimes occur, in our experience many can be managed conservatively.

Gastrostomy in Infants With Neonatal Pulmonary Disease

ABSTRACTObjectiveTo report our experience of enteral feeding via gastrostomy in children with severe chronic neonatal lung disease, failure to thrive, and oral aversive behavior after initial hospitalization.PopulationThirteen patients were studied. All children had chronic lung disease of neonatal onset and were severely malnourished. They received enteral nutrition via a gastrostomy at a median age of 13 months (range: 8–35).ResultsZ‐scores for weight‐for‐height increased significantly, from −3.4 to −1.9 after four months of enteral nutrition. Caloric intake increased significantly from 100% to 140% of the recommended daily allowance for age. Pulmonary status remained stable for all patients and oxygenation was normal. There was an aggravation of oral aversive behavior in 7 of the 13 children, especially those children who were ventilated and hospitalized for a long time (median duration: 195 days). The median follow‐up of patients after gastrostomy was 30 months (range: 8–54) and only six patients could be weaned from enteral nutrition.ConclusionEnteral nutrition via gastrostomy is efficient, and provides the means to improve caloric intake and nutritional status. Gastrostomy is a safe and convenient technique that should be considered early in the course of treatment for infants presenting with malnutrition related to neonatal pulmonary disease.