Peristomal Leakage Research Articles

Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy May Be Improved by Proper Pre- and Post-Positioning Management of Elderly Patients with Multimorbidity.

The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol. This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed. No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication-buried bumper-was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%). The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information.

Predictors of Health-Related Quality of Life in Younger Persons With a Fecal Ostomy and Inflammatory Bowel Disease.

The purpose of this study was to determine predictors of health-related quality of life (HRQOL) in persons aged 18 to 40years living with inflammatory bowel disease (IBD) and a fecal ostomy. Descriptive cross-sectional study. The sample comprised 98 participants recruited from online discussion boards/support groups for individuals living with IBD and an intestinal ostomy. More than three-quarters (76.5%) were female; 45.9% (n=44) had lived with an ostomy for 2years or less. Data were collected through an online survey made available from October 2018 to December 2018. HRQOL was measured using the Healthy Days Core Module (Centers for Disease Control and Prevention HRQOL-4). Item 1 from the CDC HRQOL-4 represented the variable self-rated health (SRH). The subscales of bodily pain, general mental health, and vitality from the Short-Form 36 Health Survey and the subscales of ostomy function and body image/sexuality plus skin irritation item from the Young-Fadok Stoma Quality of Life (QOL) Scale were used to measure predictors of pain, psychological distress, fatigue, peristomal skin irritation, leakage of ostomy appliance, and body image/sexual disturbance. Correlational and hierarchical multiple linear regression analyses were conducted to complete hypotheses testing. Significant correlations were found between pain, fatigue, peristomal skin problems, psychological distress, SRH, and HRQOL. Pain, fatigue, psychological distress, and self-related health explained 53.2% of the variance in HRQOL based on hierarchical multiple linear regression and controlling for demographic variables such as marital and employment status. Findings suggest global disease symptoms of IBD in the form of pain, fatigue, and psychological distress and individual perception of health (SRH) are more important than transient ostomy symptoms of peristomal skin complications and leakage of ostomy appliance in predicting HRQOL. Individuals in this population regularly use online resources indicating a need to understand and gain insight into the information posted online in the management of the fecal ostomy and IBD.

Percutaneous Endoscopic Gastrostomy: Insertion and Management

Percutaneous endoscopic gastrostomy (PEG) is the modality of choice for long-term enteral feeding in patients in whom oral intake is challenging. Compared with parenteral nutrition, gastrostomy feeding is the preferred choice for sustained nutritional support. Delivery of nutrients directly to the gastrointestinal tract and enhanced cellular immunity associated with this approach are clinically beneficial to patients. Endoscopic gastrostomy is favored for its high clinical success rates and economic advantages and is associated with minor discrepancies with regard to morbidity, mortality, and tube function compared with surgical gastrostomy. PEG procedures can be broadly classified into the pull- and push-types. Although PEG is a comparatively safe procedure, high risk of bleeding is a well-known complication of PEG placement, which necessitates prophylactic antibiotic therapy and careful periprocedural management in patients who receive antiplatelet and anticoagulant agents. Tube dislodgement, peristomal leakage, or infection following PEG placement may require tube replacement or removal. In this review, we investigated the concerns associated with early vs. delayed feeding in concordance with current guidelines. We also describe the indications for PEG tube insertion, post-procedural care strategies, and management of complications.

Tube cystostomy is effective for urinary outflow management in dogs with intervertebral disk extrusion and ischemic myelopathy cranial to the L3 spinal cord segment: 61 dogs (2018-2022).

To describe the application and owner experience of tube cystostomy for management of upper motor neuron urinary bladder dysfunction secondary to intervertebral disk extrusion (IVDE) or ischemic myelopathy, and to report complications associated with cystostomy tube management. 61 dogs. Medical records of dogs with IVDE or ischemic myelopathy cranial to the L3 spinal cord segment that underwent tube cystostomy placement via a short, caudal ventral midline celiotomy were reviewed. Days from tube placement to hospital discharge, days from placement to tube removal, and complications were recorded. An owner questionnaire was distributed to ascertain ease of use and perceived time commitment. 58 dogs were diagnosed with IVDE, and 3 dogs were diagnosed with ischemic myelopathy. The modal neurologic grade at cystostomy tube placement was 4 (range, 3 to 5). The median number of days from cystostomy tube placement to hospital discharge was 1 (range, 0 to 3). Follow-up data was available for 56 dogs. The median number of days from cystostomy tube placement until removal was 19 (range, 3 to 74). Fifteen minor and 6 severe postoperative complications were reported, mainly inadvertent removal (n = 11) and peristomal urine leakage (6). Twenty-seven owners responded to the questionnaire and primarily reported that cystostomy tube use was easy (22/27) and perceived time commitment was low or minimal (20/27). Tube cystostomy facilitates early hospital discharge and allows at-home, extended urinary management in dogs recovering from upper motor neuron urinary bladder dysfunction secondary to IVDE or ischemic myelopathy. This technique is simple for owners to use.

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.

Tutorial on adult enteral tube feeding: Indications, placement, removal, complications, and ethics.

Enteral nutrition, generally preferred to parenteral nutrition, is indicated when patients cannot meet their energy and metabolic demands. Gastrostomy tubes are placed directly into the stomach (either endoscopically, surgically, or radiologically) through the abdominal wall. Routine gastrostomy tube care is important to maintain well-functioning tubes. Postpyloric feeding tubes are preferable to gastric feeding tubes if patients have a history of aspiration, gastroesophageal reflux, severe gastroparesis, and/or recurrent nausea and vomiting. Feeding jejunostomy tubes are placed surgically and are indicated if gastric feeding is unsafe or impossible. Dual-lumen gastrojejunostomy tubes are used when both gastric decompression and feeding are desired. The general risks of enteral tube feeding include diarrhea, metabolic derangements, and aspiration. Additional complications for gastrostomy tubes, which can arise at any time, include tube dysfunction (clogging or deterioration), infection, bleeding, peristomal leakage, ulceration, gastric outlet obstruction, and accidental removal. After percutaneous endoscopic gastrostomy placement, there are also early or late complications that may occur. Multiple factors should be considered in the decision-making process for feeding tube placement. It is important to be realistic about the patient's prognosis and goals and to discuss the risks and benefits ahead of time. Consultation with palliative care or clinical ethics specialists should be considered in certain clinical scenarios.

Challenges faced by people with a stoma: peristomal body profile risk factors and leakage.

The Ostomy Life Study 2019 aimed to obtain a better understanding of the challenges faced by people with stoma. Online survey with participants from 17 countries. Of the 54 614 individuals invited to take part, 5187 responded; 62% of the respondents avoided physical and social activities because of their stoma and 37% had never consulted their stoma care nurse to have the fit of their stoma product checked. In a subgroup receiving questions on leakage (n=4209), output under the baseplate and leakage onto clothes were experienced within the previous month by 76% and 26% of respondents, respectively. Higher chance of leakage was associated with an irregular stoma shape and peristomal body profile; a stoma level at or below the skin surface; and the presence of creases, folds and other changes in the peristomal area. Leakage and access to a stoma care nurse to provide the necessary care and guidance remain important concerns for individuals with a stoma.

Is Roux-en-Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes.

Roux-en-Y jejunostomy (REYJ) may establish feeding in children with foregut dysmotility or severe gastro-esophageal reflux disease (GERD). Nevertheless, concerns have been raised about safety and efficacy. We, therefore, evaluated outcomes of REYJ by systematic review to determine if this was a satisfactory option for achieving enteral autonomy in children with complex nutritional needs. A PRISMA-adherent systematic review was conducted of studies reporting children undergoing feeding REYJ. Two authors performed processes independently; the senior author resolved disagreements. Embase, CINAHL and Medline were searched (inception-01/21). Additional databases, references, and 'grey' literature were searched. Methodological Index for Non-randomized Studies (MINORS) and a bespoke system assessed methodological quality. Of 362 articles, 10 met eligibility criteria (9 retrospective series; 1 conference proceeding). Unpublished data were also attained. Interobserver agreement for MINORS (kappa = 0.47) and bespoke scoring (kappa = 0.58) were moderate. After consensus, median MINORS score was 37.5% (IQR 6.3%) and bespoke 50% (IQR 20.8%), indicating poor methodological quality. One hundred sixty-four patients were reported (age range: 2 months to 19 years). Time to full feeds and length of stay were inadequately reported but most achieved enteral autonomy. No studies reported patient/caregiver-questionnaires. Seventy-six complications were documented (Clavien-Dindo grading was infeasible). Morbidity included peristomal leakage (N = 26), internal hernia/volvulus (N = 8), and SSI (N = 7). Thirty-eight patients died (2 procedure-attributable) during follow-up (range: 1 month to 15 years). Up to 50% patients experience complications after REYJ (often minor) with 23% patients dying during follow-up, often comorbidity-attributable. REYJ can achieve enteral autonomy although parents/caregivers of children should be counselled accordingly.

69-Year Old Man With Dysphagia and Nasal Regurgitation

69-Year Old Man With Dysphagia and Nasal Regurgitation

Managing complications of percutaneous tracheostomy and gastrostomy.

Percutaneous tracheostomy and gastrostomy are some of the most commonly performed procedures at bedside in the intensive care unit. While they are generally considered safe, they can be associated with numerous short and long-term complications, many of which can occur long after their placement and cause significant morbidity. Performers of these procedures should possess a comprehensive understanding of procedural indications and contraindications, and know how to recognize and manage complications that may arise. In this review, we highlight complications of percutaneous tracheostomy and describe strategies for their prevention and management, with a special focus on post-tracheostomy tracheal stenosis. Other complications reviewed include bleeding, pneumothorax and subcutaneous emphysema, posterior wall injury, tube displacement, tracheomalacia, tracheoinominate artery fistula, tracheo-esophageal fistula, and stomal cellulitis. Gastrostomy complications and their management are also discussed including bleeding, internal organ injury, necrotizing fasciitis, aspiration pneumonia, buried bumper syndrome, tumor seeding, wound infection, tube displacement, peristomal leakage, and gastric outlet obstruction. In light of the potentially serious outcomes associated with complications of percutaneous tracheostomy and gastrostomy, the emphasis should be placed on risk-reduction strategies to minimize morbidity and mortality. We therefore present detailed pragmatic and comprehensive checklists to serve as a reference for clinicians involved in performing these procedures.

Per-oral image guided gastrojejunostomy insertion for levodopa-carbidopa intestinal gel in Parkinson's disease is safe and may be advantageous

Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques. We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension. Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient). In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J.

A technique for managing the off-centre stoma os to prevent peristomal skin complications and pouch leakage

A technique for managing the off-centre stoma os to prevent peristomal skin complications and pouch leakage

Clinical Outcomes of Patients undergoing Intracutaneously and Transcutaneously Sutured Ileostomy to Prevent Stoma Related Complications- A Cohort Study

Introduction: Ileostomy plays an important role in the emergency settings when faecal diversion procedure would be lifesaving. As it is known that each procedure has some complications, ileostomy is no different than having a plethora of complications ranging from early to late complications. Aim: To determine outcomes in patients undergoing intracutaneously compared with transcutaneously sutured ileostomy to prevent stoma related complications. MaterialsandMethods:Aprospectivecohortstudywasconducted on 130 patients who received a loop ileostomy from October 2018 till August 2020. Patients were placed in either transcutaneously sutured ileostomy group (n=70) or intracutaneously sutured ileostomy group (n=60), on the basis of surgeon’s choice. Patients were followed for a period of three months after surgery and its outcomes (complications like peristomal dermatitis, ischaemia, prolapse etc.,) were assessed and compared using Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corp.) and independent sample’s t-test. Results: The mean age for intracutaneously sutured ileostomy was 38.62±19.01 years and that for transcutaneously sutured ileostomy was 33.89±13.25 years. There was no significant difference between the groups in terms of age (p=0.420). There was no significant difference between the various groups in terms of distribution of gender (p=0.753). Nearly half of the patients (43.9%) suffered from peristomal leakage 33 (55%) in intracutaneously sutured ileostomy and 24 (34.3%) in transcutaneously sutured ileostomy (p-value- 0.018) leading to peristomal dermatitis. Conclusion: Transcutaneous suturing technique have shown to decrease incidence of peristomal leakage leading to skin irritation (peristomal dermatitis). Other stoma related complications did not differ between the two techniques.

Automated Assessment of Peristomal Skin Discoloration and Leakage Area Using Artificial Intelligence.

For people living with an ostomy, development of peristomal skin complications (PSCs) is the most common post-operative challenge. A visual sign of PSCs is discoloration (redness) of the peristomal skin often resulting from leakage of ostomy output under the baseplate. If left unattended, a mild skin condition may progress into a severe disorder; consequently, it is important to monitor discoloration and leakage patterns closely. The Ostomy Skin Tool is current state-of-the-art for evaluation of peristomal skin, but it relies on patients visiting their healthcare professional regularly. To enable close monitoring of peristomal skin over time, an automated strategy not relying on scheduled consultations is required. Several medical fields have implemented automated image analysis based on artificial intelligence, and these deep learning algorithms have become increasingly recognized as a valuable tool in healthcare. Therefore, the main objective of this study was to develop deep learning algorithms which could provide automated, consistent, and objective assessments of changes in peristomal skin discoloration and leakage patterns. A total of 614 peristomal skin images were used for development of the discoloration model, which predicted the area of the discolored peristomal skin with an accuracy of 95% alongside precision and recall scores of 79.6 and 75.0%, respectively. The algorithm predicting leakage patterns was developed based on 954 product images, and leakage area was determined with 98.8% accuracy, 75.0% precision, and 71.5% recall. Combined, these data for the first time demonstrate implementation of artificial intelligence for automated assessment of changes in peristomal skin discoloration and leakage patterns.

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution

Introduction: Superior mesenteric artery syndrome (SMAS) is a relatively rare cause of chronic duodenal obstruction, owing to the compression of the third portion of the duodenum. Objectives: This retrospective study aims to discuss the efficacy of enteral nutrition (EN) therapy in nutritional status and symptom improvement at a short-term follow-up for SMAS patients. Methods: We retrospectively analyzed clinical data of patients diagnosed as SMAS and treated with EN from September 2012 to January 2019. Results: Twenty-six patients were included (16 women; mean age 24.96 ± 11.77 years), none was excluded, and one was lost to follow-up. The patients’ mean body weight was 40.94 ± 10.16 kg, mean weight loss 11.73 ± 7.58 kg, and mean body mass index (BMI) 14.82 ± 2.52 kg/m². The mean duration of EN therapy was 10.10 ± 4.66 months. Serum level of nutritional indicators, BMI and body weight increased after EN therapy. During a median follow-up of 24 months (9–44) after EN therapy, the mean symptom score decreased from 24.28 ± 9.57 to 8.06 ± 8.29 (p < 0.0001), and 65% of patients’ symptoms resolved and 15% of patients’ symptoms improved. In total, 16 complications occurred, including tube blockage, peristomal wound infections, peristomal leakage, granulomas, and nasopharyngeal pain. Conclusion: EN therapy may be an effective option for SMAS patients. While it might not remove all symptoms, it can improve the nutritional status to support subsequent treatments.

General principles for the prevention and treatment of complications of percutaneous endoscopic gastrostomy (review of literature)

We considered the views of researchers presented in the modern literature on both the problem as a whole and discussion questions regarding the causes of development, preventive measures, and methods of treating percutaneous endoscopic gastrostomy complications, such as clogging of the gastrostomy tube, peristomal wound infections, necrotic fasciitis, pneumoperitoneum, buried bumper syndrome, growth of granulations in the gastrostomy zone, postoperative bleeding and intraparietal hematoma of the gastric wall, traumatic dislocation of the gastrostomy tube, peritonitis after percutaneous endoscopic gastrostomy, peristomal leakage, сolonic fistula, liver injury and abdominal wall metastasis at the percutaneous endoscopic gastrostomy site.

1897 Endoscopic Closure of GastroColoCutaneous Fistula: A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Placement

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) tube placement is an indispensable method for enteral nutrition. The incidence of complications ranges from 0.4% to 40% .These include buried bumper syndrome, infection, tube dislodgement, malfunction, peristomal leakage, bleeding and colonic perforation. We report a rare complication of colonic perforation presenting as a gastrocolocutaneous fistula. CASE DESCRIPTION/METHODS: 55-year-old male with Stage IV gastroesophageal junction neuroendocrine carcinoma with ongoing chemoradiotherapy had a PEG tube placed for dysphagia. There were no post procedural complications. Two months post procedure, patient presented with pancytopenia and a two-week history of persistent diarrhea, malodorous peristomal drainage and weight loss. Computerized tomography (CT) imaging with intravenous (IV) contrast confirmed the presence of a gastrocolocutaneous fistula (Image A, left) with internal bolster located in the transverse colon. Due to immunocompromised status, endoscopic closure was pursued with a colonoscopy and esophagogastroduodenoscopy (EGD). A pediatric colonoscope with distal cap attachment was used, an internal bolster with colocutaneous fistula with no cologastric fistula was seen. (Image B). The site was tattooed with 6mL of Spot (carbon black). The gastrostomy tube was removed, and three hemostatic clips were used for closure (Image C, left). No air leak was noted over the exterior abdominal wall. This was followed by EGD, the residual gastrocolic fistula was closed by a mini over the scope clip (OTSC) OVESCO 10/3t (Image C, right). A CT scan with oral contrast demonstrated no residual leak/fistula. (Image A, right) Total parenteral nutrition (TPN) was initiated. Patient continued to do well, and post-procedural hospital stay was uneventful. DISCUSSION: Gastrocolocutaneous fistula after PEG placement has an incidence of 0.5%–3%. Risk factors include lax mesentery, prior abdominal surgery leading to adhesions and improper insufflation of the stomach. Peritoneal signs represent acute presentations, delayed presentations manifest as feculent peristomal leakage, persistent diarrhea and weight loss. Diagnosis can be made with oral and IV enhanced imaging. Conservative management includes removal and allowing fistula healing. Surgical intervention is warranted when systemic signs or persistent fistulous tract is present. Endoscopic closure with OTSC is described as a treatment option for uncomplicated patients.

Gastrostomy tubes appear to be safe following pediatric orthotopic heart transplant.

Gastrostomy tube (GT) placement is a common pediatric surgical procedure typically indicated for oral aversion. This may develop in patients with congenital heart disease (CHD) who require an orthotopic heart transplant (OHT). The safety profile of GT placement in OHT patients who are immunosuppressed is unknown. Given the potential increased risk of wound site complications on a patient receiving immunosuppression, we sought to determine the safety profile of GT placement in pediatric patients with OHT. We performed a retrospective case series of all pediatric OHT recipients who subsequently underwent GT placement from January 1, 2009, to August 1, 2018, at the University of Virginia Children's Hospital. Major GT complications of wound breakdown, wound infection, peristomal GT leakage, ileus, or persistent emesis, and minor GT complication including the presence of granulation tissue are reported. Six patients who had a pediatric OHT subsequently underwent GT placement over the study period. There were no major 30-day or 90-day GT complications. One patient had excessive granulation tissue at their GT site. There were no accounts of acute kidney injury, urinary tract infection, sepsis, or pneumonia. Gastrostomy tube (GT) placement appears to be safe in pediatric OHT patients who are on immunosuppressive medications and unable to feed orally. This is the first study documenting the safety profile of GTs in pediatric OHT patients and may aid clinicians to make decisions regarding this intervention.

Assessment of risk factors on morbidity and mortality in patients undergoing percutaneous endoscopic gastrostomy

Aim: Percutaneous endoscopic gastrostomy (PEG) is a minimal invasive procedure that is performed in patients who are unable to take oral feeding. Herein, we aimed to assess the risk factors for morbidity and mortality in patients who undergo PEG. Material and Methods: This study was conducted, in a total of 143 patients who underwent PEG for enteral feeding, who were retrospectively analyzed in terms of clinical features, biochemical, hematological and microbiological parameters, and also morbidity and mortality. Results: The study enrolled 140 of 143 consecutive patients who underwent PEG, and a total of 206 interventions were performed. The rate of successful insertion was 98.5% (140/142). Complications were peristomal leakage (%29.3), infection due to PEG (9.3%), and tube blockage (6.4%), respectively. In multivariate logistic regression analysis; a ≤ 3.5cm length of the PEG tube between the gastric mucosa and the skin (95% CI: 1.290-33.442 and P= 0.023) and a low platelet lymphocyte ratio (OR = 0.994, 95% CI: 0.989-0.999 and p = 0.022) were risk factors of peristomal leakage. The 30-day mortality rate was 16%. Discussion: In patient with PEG, the complication rate varies between 5% and 66% according to follow-ups in the literature. The mortality usually depends on the primary disease, and it has been reported between 5% and 20%. Conclusion: PEG is a safe, effective, and minimal invasive procedure. A ≤3.5 cm length of a PEG tube between the gastric mucosa and skin and a low platelet lymphocyte ratio are risk factors for the development of peristomal leakage.

Peristomal leakage of enteroatmospheric fistulas treated with lipotransfer combined to minimal-invasive scar release technique

Lipografting is emerging as a “rescue” treatment for postoperative sequelae, soft tissue volume defects and refractory fistulas. After complicated laparotomies or colostomies, also peristomal soft tissue volume deficiencies and scarring can occur and lead to severe care problems. Currently, no satisfactory treatment is available for these sequelae resulting in general surgery. In this case report, we applied the operative approach by means of a minimal-invasive scar release combined to waterjet-assisted lipotransfer and sculpturing on the abdominal wall as a treatment of peristomal irregularities. We applied one procedure on a patient with insufficient stoma sealing on large enteroatmospheric fistulas in “frozen” open abdomen (Bjork 4 classification). Clinical and aesthetic outcome were measured and evaluated via digital photographs and CT scan pre- and postoperatively. Size reduction, complete sealing of the stoma appliance and total healing of the peristomal skin damage were accomplished within 5 weeks. Level of Evidence: Level V, therapeutic study.