Gastrostomy revision: incidence and indications.

BACKGROUND/PURPOSE: Although quite reliable, gastrostomy may require revision. However, there are no reports in the literature specifically delineating identifiable risk factors or circumstances that lead to gastrostomy revision in children with gastrostomy. The purpose of this report was to determine the rate of revision and correlate any factors that may lead to revision. METHODS: A retrospective chart review was performed on 1,042 children who underwent gastrostomy at The Children's Hospital, Denver, Colorado, between 1992 and 2002. Charts of children who underwent gastrostomy were reviewed for pertinent clinical factors and compared with those who required gastrostomy revision. RESULTS: Of the 1,042 children, who had gastrostomies, 67 revisions were required in 61 children (6%). Of the many possible factors that could have had an influence on the revision rate, only fundoplication, percutaneous endoscopic gastrostomy (PEG), migration of the gastrostomy site, and time correlated with the need for gastrostomy revision. CONCLUSIONS: Parents should be made aware that there is a 6% chance that their child's gastrostomy may need revision and that the need for revision may increase with PEG, initial construction before 18 months of age, and the advancing age of the gastrostomy. Surgeons should avoid placing the gastrostomy near the costal margin, making a large gastrostomy exit tract through the abdominal wall and inserting a gastrostomy into the nutritionally depleted pulmonary stressed neurologically challenged child without first attempting to improve the child's nutritional status.

Analysis of factors affecting the spontaneous closure of a gastrocutaneous fistula.

BACKGROUND/PURPOSE: Few reports have documented the rate of persistence of a gastrocutaneous fistula (GCF) after gastrostomy removal or the reason for the persistence of a GCF. The purpose of this report was to analyze a large group of pediatric patients with a persistent GCF to determine the rate of persistence and any factors that correlate with the persistence of a GCF. METHODS: This was a retrospective review of 1,042 children from The Children's Hospital, Denver, Colorado who had a gastrostomy constructed between 1992 and 2002. The charts of all children with a persistent GCF after gastrostomy catheter removal were analyzed for correlation between 13 clinical parameters and the persistence of a GCF. RESULTS: There were 150 children with a persistent GCF for an incidence of 34%. Time elapsed between the creation of the GCF and removal of the gastrostomy appliance (< or =8 months versus >8 months) was the only parameter that showed any correlation with persistence of a GCF (P <.05). None of the other parameters studied showed any conclusive correlation with persistence of a GCF. CONCLUSIONS: Time was the only factor that determined whether a surgically created GCF would persist after removal of a gastrostomy appliance.

Gastric prolapse through a gastrostomy tract.

BACKGROUND/PURPOSE: Few reports have documented the incidence or the characteristics of children with gastric prolapse through a gastrostomy tract. The purpose of this report was to determine the incidence of gastric prolapse through a gastrostomy tract and to identify the salient features associated with gastric prolapse. METHODS: This was a retrospective review of 1,042 children from The Children's Hospital, Denver, CO who had a gastrostomy constructed for enteral access between 1992 and 2002. The charts of children who had gastric prolapse through the gastrostomy tract were scrutinized to obtain a profile of the children who had prolapse, and 14 parameters were analyzed for correlation with the incidence of this complication. RESULTS: Thirteen children had gastric prolapse through the gastrostomy tract for an incidence of gastric prolapse of 1.2%; 5 children had recurrent gastric prolapse through a gastrostomy tract for an incidence of recurrent gastric prolapse of 0.5%. Gastric prolapse occurred more often in children with ventilator dependence (31%), poor nutrition (54%), and neurologic disorders (58%). Gastrostomy devices with both ends fixed and rigid were associated with gastric prolapse (2.7%) more often than devices with only 1 end fixed and rigid (0.6%). Laparoscopic gastrostomy was associated with gastric prolapse and recurrent gastric prolapse more often than other gastrostomy construction techniques. CONCLUSIONS: Children with poor nutrition, ventilator dependence, a neurologic disorder, a gastrostomy device with both ends fixed and rigid, and/or a laparoscopic gastrostomy, were prone to gastric prolapse.