Laparoscopic Gastrostomy Research Articles

The Effect of Educational Guidelines on Nurse Performance for Patients Undergoing Percutaneous Laparoscopic Gastrostomy

The Effect of Educational Guidelines on Nurse Performance for Patients Undergoing Percutaneous Laparoscopic Gastrostomy

Evaluating the use of laparoscopic gastrostomy in children with congenital heart disease in Colombia: a retrospective analysis

Evaluating the use of laparoscopic gastrostomy in children with congenital heart disease in Colombia: a retrospective analysis

Impact of Language Congruence on Patient Outcomes Following Gastrostomy Tube Insertion.

Inadequate health literacy poses a significant public health challenge, influencing patient treatment adherence and outcomes. This study explores outcomes in the setting of language congruence at the time of discharge for pediatric patients following laparoscopic gastrostomy tube insertion. We conducted a retrospective chart review from 2019 to 2022 at a community children's hospital, including 168 patients categorized based on language congruence. Although trends did suggest increased ER visits among Spanish-speaking patients, there were no statistically significant differences in health care utilization or patient outcomes identified. Further larger studies are needed for a comprehensive analysis of the relationship of language congruence at discharge on outcomes following surgical procedures as this may enable delivery of culturally competent medical care.

Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades

BACKGROUND Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature. AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival. METHODS In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis. RESULTS In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals (P < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% (n = 34060), 23.3% (n = 11336), and 4.9% (n = 2404), respectively. Procedure-related mortality was 0.1% (n = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 vs 8.5% in 2010-2019 (P < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases. CONCLUSION The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.

Modifiable Preoperative Risk Factors to Mitigate Postoperative Site Infection Following Pediatric Gastrostomy

PurposeThere are limited studies assessing modifiable preoperative risk factors for pediatric laparoscopic gastrostomy tubes (LGT) and percutaneous endoscopic gastrostomy (PEG) tubes. We sought to evaluate the effect of demographics and surgical/infectious history on the superficial infection rate following gastrostomy tube (GT) placement. MethodsAfter IRB approval, we conducted a single-institution retrospective cohort study from 2015 to 2021 of pediatric patients undergoing LGT or PEG tube. The primary outcome was cellulitis or abscess formation within 30-days and 90-days postoperatively. Statistical analyses were performed with t-tests, Chi-squared, and logistic regression(p ≤ 0.05). ResultsThere were 382 patients, with 181 (47%) LGT and 201 (53%) PEGs. LGT patients were younger (5.9 vs. 12.3 months, p < 0.001) and more likely to be admitted to the neonatal or cardiac intensive care unit prior to their GT. There were similar rates of prior surgical intervention (58% vs. 66%, p = 0.29) and previous infection (37% vs. 38%, p = 0.87) in both LGT and PEG patients. Within 30-days postoperatively, LGT patients had a higher superficial infection rate (12% vs. 6%, p = 0.04). On multivariate regression, Black race (Odds Ratio 0.10, p = 0.03) was protective and prior Staphylococcus colonization (OR 2.35, p = 0.04) increased the odds of infection. In those patients colonized with Staphylococcus, 21% developed a superficial site infection compared to 9% in those not colonized (p = 0.01). ConclusionThese data suggest prior Staphylococcus colonization is a significant risk factor for superficial infection following GT. Further work into preoperative decolonization strategies may provide an avenue to decrease the high infection rate in this common pediatric procedure. Level of EvidenceLevel III.

Percutaneous endoscopic gastrostomy in children receiving peritoneal dialysis: A tertiary centre long-term experience and literature review.

Children with severe chronic kidney disease receiving maintenance peritoneal dialysis (PD) are often malnourished and may require nutritional supplementation. Recent PD guidelines address laparoscopic and open surgical gastrostomy as safe approaches in children established on PD, while existing evidence on percutaneous endoscopic gastrostomy (PEG) is still lacking; as well as the role of perioperative antibiotic and antifungal prophylaxis. Hence, this study aimed to report our experience with PEG placement in patients on PD and compare it with the available literature. We retrospectively reviewed the medical records from patients on PD, who underwent PEG placement at a tertiary referral centre between 2000 and 2020. Data on perioperative management, complications and outcomes were retrieved. An extensive literature search was performed; studies describing PEG placement and perioperative prophylaxis in patients on PD were used as a comparison. Descriptive statistical analysis was conducted. Seven patients (five males) were included. Perioperative antibiotic and antifungal prophylaxis were standard practice. At a median follow-up of 27 months (10-75), the peritonitis rate was 0.2 patient/years. No statistical significance was found between the peritonitis rate before and after PEG placement (p = 0.2). Patients' demographics and postoperative complications were comparable to the reported studies. Based on our experience, our technique of PEG insertion with antimicrobial prophylaxis is feasible and associated with an acceptable complication risk in patients on PD. Further multicentric studies about surgical technique in patients on PD will be necessary to verify the feasibility of PEG and standardise the perioperative protocol.

Prophylactic anti-reflux procedure for children undergoing laparoscopic gastrostomy: Rethinking of the routine practice.

Laparoscopic gastrostomy is a frequently performed procedure in children requiring long-term enteral nutrition. The role of prophylactic anti-reflux surgery during gastrostomy placements is controversial. The current study aims to evaluate the role of prophylactic anti-reflux procedures during gastrostomy placement. A retrospective single-center analysis of all children without reflux receiving laparoscopic gastrostomy from January 2005 through December 2021 was performed. Demographics and clinical outcomes were compared between patients receiving gastrostomy placement alone and patients receiving gastrostomy with prophylactic anti-reflux surgery. A total of 79 patients had a confirmed absence of reflux by a 24-h pH/impedance study before operation. Thirty-six of these patients underwent prophylactic anti-reflux surgery (PAR) while 43 received gastrostomy (PG) alone. The operative time and conversion rate were significantly higher in the PAR group (140.5±67.5 vs. 80.2±66.8min, p=0.0001 and 8.3% vs. 0%, p=0.04). There were no major complications in either group. De novo reflux was detected in five patients (11.6%) in the PG group. None of these patients progressed to require anti-reflux surgery. The occurrence of de novo reflux after laparoscopic gastrostomy was low and could be managed without anti-reflux surgery. A routine pre-operative pH study is helpful for appropriate patient selection to avoid unnecessary anti-reflux surgery, which lengthens operative time and increases the conversion rate.

Laparoscopic Gastrostomy from the Anterior Wall of the Stomach: a Simple Gastrostomy Technique with Maximal Preservation of Stomach Integrity

Laparoscopic Gastrostomy from the Anterior Wall of the Stomach: a Simple Gastrostomy Technique with Maximal Preservation of Stomach Integrity

IBC-Oxford University2023_BJSPoster_10Surgical management of intra-gastric balloon complications

Abstract In Saudi Arabia, the intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications has been reported for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. We aim to report our experience as a tertiary university hospital in the Eastern Province of Saudi Arabia in dealing with different complications of IGBs that necessitated any type of surgical interventions. A retrospective descriptive study was conducted in a tertiary hospital in Saudi Arabia for 5 years to include all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively, and any complications related to other bariatric procedures. Six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had esophageal rupture that required left thoracotomy, pleural flap and insertion of an esophageal stent. All cases were discharged and followed up with no related complications.

Surgical technique-related complications of pediatric gastrostomy

IntroductionGastrostomy is a commonly performed procedure in pediatric patients, with various surgical techniques available for its application. However, no consensus exists regarding the optimal technique. This study aims to evaluate the outcomes and complications associated with different surgical techniques used for gastrostomy in children. MethodsThis retrospective cohort study involved a review of medical records from patients who underwent gastrostomy using any of the four techniques employed at Fundación HOMI. A statistical analysis was conducted to determine the correlation between surgical technique and the occurrence of early and late complications. ResultsA total of 350 patients were included in the study, with a mean age of 47.3 months (SD: 3 months). The open technique was utilized in 43.3 % of cases, endoscopic in 31.7 %, Laparoscopic-assisted percutaneous endoscopic gastrostomy in 12.6 %, and laparoscopic in 12.3 %. Early complications were observed in 27.1 % of patients, while late complications occurred in 24.86 % of cases. No correlation was found between the occurrence of complications and patient age, comorbidities, surgical indication, additional procedures performed during gastrostomy, or surgeon experience. However, laparoscopic gastrostomy was significantly correlated with peristomal leakage (p = 0.0002). We conducted long-term (at least three months) postoperative follow-up of 247 patients. ConclusionsThis study highlights a significant correlation between laparoscopic gastrostomy and peristomal leakage. However, no standard or preferred technique for performing gastrostomy in children has been identified.

Gastrostomies: experience and complications with three modalities in a tertiary centre over a 26-year period.

To describe the complications associated with the different gastrostomy techniques [endoscopic (PEG), radiologic (PRG), and surgical (SG)] performed in the last 26 years in a terciary hospital. Retrospective observational study. Patients who underwent gastrostomy at the Virgen del Rocío University Hospital between 1995 and 2021 were included. For PEG, the PULL technique was performed until 2018 and subsequently the PUSH technique predominantly. For PRG, a pigtail catheter was used until 2003, a balloon catheter between 2003 and 2009, and a balloon catheter with gastropexy between 2015 and 2021. For SG, the conventional technique (CSG) was performed until 2009 and since then the laparoscopic assisted percutaneous gastrostomy (PLAG) technique. Descriptive analysis was performed obtaining the median and quartiles of the quantitative variables [P50 (P25-P75)] and the frequency for the qualitative variables [n (%)].The comparison of complications between patients who underwent different techniques was performed with Fisher's test. n = 1,070 (PEG = 608, PRG = 344, SG = 118). The three most frequent indications were head and neck tumors, neurological diseases and gastroesophageal tumors. The percentage of patients who had any complication was 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 38.5% (pigtail PRG), 39.2% (balloon PRG), 29.7% (balloon with gastropexy PRG), 87.3% (CSG), and 41.26% (PLAG). 2 (0.18%) patients died from gastrostomy-related complications. 18(1.68%) presented with peritonitis and 5 (0.4%) presented with gastrocolic fistula. The rest of the complications were minor. Gastrostomy in any of its modalities is currently a safe procedure with a low rate of complications, most of which are minor.

Literature review of techniques for primary laparoscopic balloon gastrostomy and report of our experience of consecutive 80 children using the Seldinger technique

Literature review of techniques for primary laparoscopic balloon gastrostomy and report of our experience of consecutive 80 children using the Seldinger technique

How Many Operative Performance Ratings Does a Pediatric Surgery Fellow Need to Be Deemed Practice Ready?

PurposeIdentifying the number of cases required for a fellow to achieve competence has been challenging. Workplace-based assessment (WBA) systems make collecting performance data practical and create the opportunity to translate WBA ratings into probabilistic statements about a fellow's likelihood of performing to a given standard on a subsequent assessment opportunity. MethodsWe compared data from two pediatric surgery training programs that used the performance rating scale from the Society for Improving Medical Professional Learning (SIMPL). We used a Bayesian generalized linear mixed effects model to examine the relationship past and future performance for three procedures: Laparoscopic Inguinal Hernia Repair, Laparoscopic Gastrostomy Tube Placement, and Pyloromyotomy. ResultsFor site one, 26 faculty assessed 9 fellows on 16 procedures yielding 1094 ratings, of which 778 (71%) earned practice-ready ratings. For site two, 25 faculty rated 3 fellows on 4 unique procedures yielding 234 ratings of which 151 (65%) were deemed practice-ready. We identified similar model-based future performance expectations, with prior practice-ready ratings having a similar average effect across both sites (Site one, B = 0.25; Site two, B = 0.25). Similar prior practice-ready ratings were needed for Laparoscopic G-Tube Placement (Site one = 13; Site two = 14), while greater differences were observed for Laparoscopic Inguinal Hernia Repair (Site one = 10; Site two = 15) and Pyloromyotomy (Site one = 10; Site two = 15). ConclusionOur approach to modeling operative performance data is effective at determining future practice readiness of pediatric surgery fellows across multiple faculty and fellow groups. This method could be used to establish minimum case number requirements. Type of StudyOriginal manuscript, Study of Diagnostic Test. Level of EvidenceII.

Open Gastrostomy by Mini-Laparotomy: Our Method.

When percutaneous endoscopic gastrostomy (PEG) is not feasible owing to anatomical obstacles, laparotomic or laparoscopic gastrostomy (LAG) is an alternative. At our institution, LAG has been the first choice for patients who are unable to undergo PEG; however, we have introduced a small open gastrostomy through a 2-cm-long transverse incision since 2020. By December 2022, 12 patients had undergone this procedure without complications. In one case where the stomach was located cephalad to the rib arch and the patient had a round dorsum, the incision wound was extended, and a lengthy operation was required. We believe that our small-incision gastrostomy is a useful option in addition to LAG for cases in which PEG is difficult to perform. Further studies are required to determine the indications for this procedure.

Outcomes in Enteral Access Based on Specialty and Approach: A Single-Center Three-Year Experience

IntroductionInterventional radiologic, endoscopic, and surgical approaches are commonly utilized to establish durable enteral access in adult patients. The purpose of this study is to examine differences in nutritional outcomes in a large cohort of patients undergoing enteral access creation. MethodsAdult patients who underwent enteral access procedures by interventional radiologists, gastroenterologists, and surgeons between 2018 and 2020 at a single institution were reviewed. Included access types were percutaneous endoscopic gastrostomy (PEG), open or laparoscopic gastrostomy, laparoscopic jejunostomy, and percutaneous gastrostomy (perc-G), percutaneous jejunostomy , or primary gastrojejunostomy. Results912 patients undergoing enteral access cases met the criteria for inclusion. PEGs and perc-Gs were the most common procedures. PEGs had higher Charlson scores (4.5 [3.0-6.0] versus 2.0 [1.0-2.0], P = 0.007) and lower starting albumin (3.0 [2.6-3.4] versus 3.6 [3.5-3.8] g/dL, P < 0.0001). Time to goal feeds (4 [2-6] vs 4 [3-5] d, P = 0.970), delta prealbumin (3.6 [0-6.5] versus 6.2 [2.3-10] mg/L, P = 0.145), time to access removal (160 [60-220] versus 180 [90-300] d, P = 0.998), and enteral access-related complications (19% versus 16%, P = 0.21) between PEG and perc-G were similar and differences were not statistically significant. A greater percent change in prealbumin was noted for perc-G (10 [-3-20] versus 41.7% [11-65], P = 0.002). ConclusionsDespite having higher Charlson scores and worse preoperative nutrition, there is a similar incidence of enteral access-related complications, time to goal feeds, delta prealbumin, or time to access removal between PEG and perc-G patients. Our data suggest that access approach should be made on an individual basis, accounting for anatomy and technical feasibility.

Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review.

In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.

Results of treatment of children with complications after burns of the esophagus from button batteries

Aim. To enhance the treatment outcomes in children with complications following an esophageal burn caused by a disk battery.Materials and Methods. We analyzed the treatment outcomes of 102 patients suffering from esophageal burns from a disk battery, who were treated at the N.F. Filatov Children’s City Hospital of the Moscow Healthcare Ministry from 2009 to 2021. Children who developed complications (n=57) were divided according to the treatment strategy employed: conservative tactics (n=36, 63.2%) and radical surgery (n=21, 36.8%).Results and Discussion. The types of surgical interventions carried out for tracheoesophageal fistula (TEF) (n=31) included laparoscopic fundoplication and gastrostomy (38.7%), separation of TEF (41.9%), and tracheal plastic surgery with an esophageal flap and extirpation of the esophagus (19.4%). Assessment of the outcomes of TEF post laparoscopic fundoplication and gastrostomy demonstrated spontaneous closure in 63.6% of the cases. The average time until closure was 5 months. Among children with esophageal stenosis (n=24), esophageal bougienage was performed in 95.8% of the cases. All children identified with esophageal perforation (n=4) were successfully treated conservatively. Tactics for managing laryngeal paresis or paralysis included conservative therapy and observation in 33.3% of cases, tracheostomy in 29.2%, and lateralization procedures in 37.5%.Conclusion. Conservative tactics demonstrated superior results in all complications, minimizing the number of postoperative complications (16.7%) and ensuring favorable long-term outcomes.

Outcomes of laparoscopic gastrostomy in children with and without the use of a modified T-fastener technique

BackgroundLaparoscopic gastrostomy is commonly performed for durable enteral access in children. T-fasteners have been used intraoperatively to achieve a secure gastropexy, traditionally using external bolsters. We compare the safety profile of a modified paired T-fastener technique to standard laparoscopic-assisted suture gastropexy. MethodsA retrospective matched case-control study was performed of pediatric patients who underwent laparoscopic gastrostomy at a single center from 2015 to 2021. In the paired T-fastener group, pairs of T-fasteners were passed into the stomach in a square configuration, allowing the suture pairs to be tied subcutaneously. This cohort was matched in a 1:2 fashion with age, sex, and body mass index or weight-matched controls who underwent laparoscopic gastrostomy with buried transabdominal gastropexy. ResultsThirty patients underwent laparoscopic gastrostomy using the paired T-fastener technique and were matched to 60 controls. There was no significant difference in median operative time or 30-day complication rates between the groups, but the paired T-fastener technique significantly reduced the number of trocars required, and it was used for patients with thicker abdominal walls. ConclusionWe demonstrate the modified paired T-fastener technique as a safe, efficient means of gastropexy in pediatric laparoscopic gastrostomy. The paired T-fastener approach eliminates external bolsters, reduces additional trocars, and may be advantageous for thicker abdominal walls while maintaining a similar complication profile to standard laparoscopic gastrostomy.

Treatment of burn complications in the esophagus caused by button batteries in children (a literature review)

Introduction. Over the past 10 years, the number of severe and fatal cases of burns in the esophagus caused by button batteries in children has increased significantly. The tactics of managing children with complications after such burns has not been defined worldwide yet; few clinical cases are described in Russian sources. Material and methods. The literature search has covered databases of RSCI, Medline and GoogleScholar published in 1983–2022. More than 350 publications on this topic have been analyzed. Results. Electrolysis is recognized as the main mechanism of tissue destruction, which is accompanied by the development of colliquative necrosis in the area of negative pole of the battery. The National Capital Poison Center, Washington, USA, recommends to neutralize burns with honey and 0.25 % acetic acid solution. The most optimal tactics for managing tracheoesophageal fistulas caused by batteries is to perform laparoscopic fundoplication and gastrostomy, as a result of which spontaneous closure of the fistula may occur. In case of large defects and patient’s severe unstable condition more complicated reconstructive interventions have to be done. Esophageal stenoses should be treated with bougienage, and perforations are preferably treated conservatively. In case of laryngeal paresis or paralysis, laryngoscopy is required at the early stage so as to understand if tracheostomy is better instead of tracheal intubation. Esophageal aortic fistulas require aggressive surgical tactics even in the absence of visible bleeding. Conclusion. Currently, there is no common management strategy in any of the possible complications. Further statistical analysis of clinical cases and assessment of existing conservative and surgical techniques are needed; development of new surgical techniques to be applied in patients with abovementioned pathology is needed as well. Rational diagnostics and curative tactics will reduce high mortality rate and improve the quality of life of such patients.

Operating Room Recycling: Opportunities to Reduce Carbon Emissions Without Increases in Cost

BackgroundThe healthcare industry is a major contributor to greenhouse gas emissions. Within the hospital, operating rooms are responsible for the largest proportion of emissions due to high resource utilization and waste generation. Our aim was to generate estimates of greenhouse gas emissions avoided and cost implications following implementation of a recycling program across operating rooms at our freestanding children's hospital. MethodsData were collected from three commonly performed pediatric surgical procedures: circumcision, laparoscopic inguinal hernia repair, and laparoscopic gastrostomy tube placement. Five cases of each procedure were observed. Recyclable paper and plastic waste was weighed. Emission equivalencies were determined using the Environmental Protection Agency Greenhouse Gas Equivalencies Calculator. Institutional cost of waste disposal was $66.25 United States Dollars (USD)/ton for recyclable waste and $67.00 USD/ton for solid waste. ResultsThe proportion of recyclable waste ranged from 23.3% for circumcision to 29.5% for laparoscopic gastrostomy tube placement. The amount of waste redirected from landfill to a recycling stream could result in annual avoidance of 58,500 to 91,500 kg carbon dioxide equivalent emissions, or 6583 to 10,296 gallons of gasoline. Establishing a recycling program would not require additional cost and could lead to modest cost savings (range $15 to 24 USD/year). ConclusionsIncorporation of recycling into operating rooms has the potential to reduce greenhouse gas emissions without increased cost. Clinicians and hospital administrators should consider operating room recycling programs as they work towards improved environmental stewardship. Level of EvidenceLevel VI – evidence form a single descriptive or qualitative study.