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Postoperative gastrostomy site leakage correlated to the dimension of the gastrostomy button in children  [cached]
Helen Sj?vie,Lars Torsten Larsson,Einar ólafur Arnbj?rnsson
Gastroenterology Insights , 2010, DOI: 10.4081/gi.2010.e9
Abstract: The laparoscopic placement of gastrostomy buttons for feeding tubes is the preferred method of gastrostomy in children with feeding requirements. This intervention often leads to some minor postoperative problems, including gastrostomy site leakage. The aim of our study was to test the hypothesis that the postoperative leakage after a video-assisted gastrostomy is correlated to the dimension of the gastrostomy button used during the oper-ation. Included in the study were 164 children with nutritional problems who consecutively underwent surgery; they had a video-assisted gastrostomy operation. In the first 87 children, a 14 French (Fr) gastrostomy button was used and in the last 77, a 12 Fr button was used. After the operation, the children were followed up prospectively and all complications were documented according to the study protocol. Our study revealed a significant correlation between the dimension of the gastrostomy button and the postoperative leakage at the gastrostomy site. The rate of leakage at the gastrostomy site was 37% in the children who had 14 Fr gastrostomy buttons compared to 18% (P=0.038) in the children who had 12 Fr gastrostomy buttons, during the first six months postoperatively. These results suggest that postoperative gastrostomy site leakage was significantly higher in children who had 14 Fr gastrostomy buttons than in those with 12 Fr buttons. To avoid this complication, 12 Fr gastro-stomy buttons should be used.
Operative technique: single-incision gastrostomy in pediatric patients
Aziz DA, Nor MM
Open Access Surgery , 2012,
Abstract: Dayang A Aziz,1 Mahmud M Nor21Paediatric Surgery Unit, Department of Surgery, UKM Medical Centre, Bandar Tun Razak, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia; 2Department of Surgery, Universiti Sains Islam Malaysia, Kuala Lumpur, MalaysiaIntroduction: Use of minimally invasive techniques for gastrostomy insertion in children is well documented. Laparoscopic placement is fast becoming the method of choice. However, it is important to note that there are still many centers in developing and under-developed countries in which laparoscopic or endoscopic facilities are not readily available.Methods: Here, we describe a less than 2 cm, single-incision open gastrostomy technique successfully performed on seven infants and one child who were all malnourished. A nasogastric tube was inserted to assist the technique.Results: All patients had a wound measuring less than 2 cm. Mean operating time was 30 minutes. Gastrostomy tube feeding was established after 6 hours post-surgery. No complications occurred in any of the patients.Conclusions: This technique is an excellent minimally invasive approach. It is simple, safe, and feasible.Keywords: minimally invasive, laparoscopic placement, children, single incision
Pre- and Postoperative Vomiting in Children Undergoing Video-Assisted Gastrostomy Tube Placement  [PDF]
Torbj?rn Backman,Helén Sj?vie,Malin Mellberg,Anna B?rjesson,Magnus Anderberg,Carl-Magnus Kullendorff,Einar Arnbj?rnsson
Surgery Research and Practice , 2014, DOI: 10.1155/2014/871325
Abstract: Background. The aim of this study was to determine the incidence of pre- and postoperative vomiting in children undergoing a Video-Assisted Gastrostomy (VAG) operation. Patients and Methods. 180 children underwent a VAG operation and were subdivided into groups based on their underlying diagnosis. An anamnesis with respect to vomiting was taken from each of the children’s parents before the operation. After the VAG operation, all patients were followed prospectively at one and six months after surgery. All complications including vomiting were documented according to a standardized protocol. Results. Vomiting occurred preoperatively in 51 children (28%). One month after surgery the incidence was 43 (24%) in the same group of children and six months after it was found in 40 (22%). There was a difference in vomiting frequency both pre- and postoperatively between the children in the groups with different diagnoses included in the study. No difference was noted in pre- and postoperative vomiting frequency within each specific diagnosis group. Conclusion. The preoperative vomiting symptoms persisted after the VAG operation. Neurologically impaired children had a higher incidence of vomiting than patients with other diagnoses, a well-known fact, probably due to their underlying diagnosis and not the VAG operation. This information is useful in preoperative counselling. 1. Introduction Gastrostomy is advocated for children with long-term nutritional feeding problems exceeding 3 months, independent of the underlying diagnosis. The percutaneous endoscopic gastrostomy (PEG) technique has been the most widely used method to achieve enteral access since its introduction in 1980 [1]. Due to an association between the PEG procedure and serious complications [2, 3] such as gastroenteric fistulas, we have, at our Department of Paediatric Surgery, chosen to use and further develop the Video-Assisted Gastrostomy (VAG) technique since 1994 [4–6]. The advantages of the VAG technique over PEG are better visual control intra-abdominally, the secure positioning of the stoma to the gastric wall, and the gastroscopic control of the gastrostomy button placement in the ventricle cavity [3, 4, 7–9]. Many centres now use the laparoscopic technique because it is considered to be a safer method [10, 11]. Vomiting is a natural physiological process in children and is associated with gastroesophageal reflux (GER) and sometimes with gastroesophageal reflux disease (GERD) [12]. Whether gastrostomies lead to exacerbation of GERD has been debated, but guidelines and consensus nowadays
Operative technique: single-incision gastrostomy in pediatric patients
Aziz DA, Nor MM
Open Access Surgery , 2012, DOI: http://dx.doi.org/10.2147/OAS.S34201
Abstract: ative technique: single-incision gastrostomy in pediatric patients Original Research (1209) Total Article Views Authors: Aziz DA, Nor MM Published Date July 2012 Volume 2012:5 Pages 23 - 25 DOI: http://dx.doi.org/10.2147/OAS.S34201 Received: 24 May 2012 Accepted: 22 June 2012 Published: 27 July 2012 Dayang A Aziz,1 Mahmud M Nor2 1Paediatric Surgery Unit, Department of Surgery, UKM Medical Centre, Bandar Tun Razak, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia; 2Department of Surgery, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia Introduction: Use of minimally invasive techniques for gastrostomy insertion in children is well documented. Laparoscopic placement is fast becoming the method of choice. However, it is important to note that there are still many centers in developing and under-developed countries in which laparoscopic or endoscopic facilities are not readily available. Methods: Here, we describe a less than 2 cm, single-incision open gastrostomy technique successfully performed on seven infants and one child who were all malnourished. A nasogastric tube was inserted to assist the technique. Results: All patients had a wound measuring less than 2 cm. Mean operating time was 30 minutes. Gastrostomy tube feeding was established after 6 hours post-surgery. No complications occurred in any of the patients. Conclusions: This technique is an excellent minimally invasive approach. It is simple, safe, and feasible.
Indications, medical conditions and services related to gastrostomy placement in infants and children at a tertiary hospital in South Africa
V Norman, SA Singh, T Hittler, N Jones, N Kenny, R Mann, S McFarlane, A Moeng
South African Journal of Child Health , 2011,
Abstract: Objectives. To describe South African infants and children requiring gastrostomies in a tertiary hospital, including the indications, medical conditions and health services, during a 5-year period (2005 - 2009). Design. The research design was a retrospective descriptive survey of medical records. Setting. A tertiary paediatric state hospital in South Africa. Subjects. One hundred and forty-two patients between the ages of 0 and 17 years. Results. Dysphagia (N=80, 56%), aspiration (N=70, 49%) and need for nutritional support (N=63, 44%) were the most common indicators for gastrostomy placement. Most participants (N=85, 75% of the subset of 114 with feeding and swallowing difficulties) presented with multiple medical conditions, and neurological impairment (N=94, 82%) and gastro-intestinal problems (N=96, 84%) were the most prominent. Services were required from a variety of health care professionals for a period ranging from 6 to 103 months (mean 18 months). The speech-language therapist was consulted most frequently before gastrostomy placement (85%), while the stoma sister (97%) and dietician (97%) were consulted after placement. Conclusions. South African infants and children requiring gastrostomies frequently present with multiple medical conditions and dysphagia. These children are likely to benefit from extended services provided by a specialised team of health care professionals.
Literature Review Comparing Laparoscopic and Percutaneous Endoscopic Gastrostomies in a Pediatric Population  [PDF]
Madelen Lantz,Helena Hultin Larsson,Einar Arnbj rnsson
International Journal of Pediatrics , 2010, DOI: 10.1155/2010/507616
Abstract: Objective. This study compares laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a paediatric population to test the hypothesis that there is a difference in the frequency of serious gastrointestinal complications between the two methods. Methods. All reports published between 1995 and 2009 on laparoscopic gastrostomy and PEG in children was included. Prospective and retrospective trials, comparing the two methods or dealing with one of them only were included. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Results. 822 publications were found when using the search terms: gastrostomy, gastrointestinal complications, and all child: 0–18 years. From these, 54 studies were extracted for this investigation. These studies reported a total of 4331 children undergoing gastrostomy operation, 1027 by using the laparoscopic technique and 3304 using the PEG technique. The number of serious gastrointestinal fistulas to colon or small bowel was 0% and .27%, respectively, <.05. Conclusions. The results suggest that by performing laparoscopic gastrostomy in children it is possible to avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG.
Literature Review Comparing Laparoscopic and Percutaneous Endoscopic Gastrostomies in a Pediatric Population  [PDF]
Madelen Lantz,Helena Hultin Larsson,Einar Arnbj?rnsson
International Journal of Pediatrics , 2010, DOI: 10.1155/2010/507616
Abstract: Objective. This study compares laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a paediatric population to test the hypothesis that there is a difference in the frequency of serious gastrointestinal complications between the two methods. Methods. All reports published between 1995 and 2009 on laparoscopic gastrostomy and PEG in children was included. Prospective and retrospective trials, comparing the two methods or dealing with one of them only were included. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Results. 822 publications were found when using the search terms: gastrostomy, gastrointestinal complications, and all child: 0–18 years. From these, 54 studies were extracted for this investigation. These studies reported a total of 4331 children undergoing gastrostomy operation, 1027 by using the laparoscopic technique and 3304 using the PEG technique. The number of serious gastrointestinal fistulas to colon or small bowel was 0% and .27%, respectively, . Conclusions. The results suggest that by performing laparoscopic gastrostomy in children it is possible to avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG. 1. Introduction The open surgical placement of a gastrostomy tube in children may cause significant complications, such as wound infection, leakage, and excessive granulation tissue. The use of a percutaneous gastrostomy tube (PEG) obviates the need for a laparotomy [1, 2]. The technique is associated with the same complications, along with the risk of inadvertent bowel injury due to a blind puncture through the abdominal cavity [3–5]. To avoid the complications associated with the PEG technique, laparoscopic-assisted gastrostomy has been used at our centre since 1994, avoiding the risk of bowel injuries [6–12]. This study aims to use a literature review to compare the frequency of serious gastrointestinal complications after laparoscopic versus percutaneous endoscopic gastrostomy (PEG) in a pediatric population. The specific question that our study intends to answer is: Does the laparoscopic procedure significantly reduce the rate of gastrointestinal complications of fistula that necessitated operation compared with PEG? We are not aware that any literature review of gastrostomy complications in a pediatric population has been performed previously to answer that question. 2. Method A systematic
Laparoscopic nephrectomy in children: Initial experience  [cached]
Shankar Gowri,Babu Narendra,Ramesh S,Srimurthy K
Journal of Indian Association of Pediatric Surgeons , 2006,
Abstract: Aims: Our objective was to evaluate the feasibility and efficacy of laparoscopic nephrectomy in infants and children. Materials and Methods: From 2000 to 2005, 28 children, aged 3 months to 14 years underwent laparoscopic nephrectomy, laparoscopic nephroureterectomy and heminephrectomy. Medical records were reviewed retrospectively for clinically relevant data. Results: There were no conversions. Mean operating time was 75 minutes and there were no intraoperative complications in our series. Cosmetic results were excellent in all cases. Average hospital stay was 4 days. Conclusions: Laparoscopic nephrectomy, laparoscopic nephroureterectomy and heminephrectomy may be safely performed in infants and children with minimal morbidity, post-operative discomfort and improved cosmesis.
Early experience with single-incision laparoscopic surgery for the placement of a gastrostomy in a 10-year-old girl: a case report  [cached]
Vanderlinden Kim,Van De Winkel Nele,De Backer Antoine,Delvaux Georges
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-375
Abstract: Introduction Access procedures for alimentation have been performed both endoscopically and surgically. In patients in whom endoscopic gastrostomy feeding tubes cannot be placed, single-incision laparoscopic surgery gastrostomy is an alternative method. This minimally invasive approach is a new technique performed through a single umbilical incision and without the need for additional laparoscopic ports. Case presentation In this article we present a case of single-incision laparoscopic surgery gastrostomy performed with conventional laparoscopic instruments in a 10-year-old girl of Caucasian ethnicity who was not a candidate for a percutaneous endoscopic gastrostomy tube because of esophageal varices due to her advanced-stage cystic fibrosis with liver cirrhosis and portal hypertension. She also had an umbilical hernia, which was repaired during the same procedure through the same incision. Access and pneumoperitoneum were obtained through the umbilicus with the single-incision laparoscopic surgery port. The selected site for the feeding tube in the stomach was exteriorized through this incision and a feeding tube was placed. The stomach was returned into the abdomen. The fascial defect, and thus also the hernia, was repaired, and the 2cm umbilical incision was closed with endocutaneous sutures. The total operative time was 25 minutes. Our patient’s intra-operative and post-operative course was uneventful. We were able to use the feeding tube on the first post-operative day with good intestinal function. Our patient and her parents were pleased with the cosmetic result. Conclusions The single-incision laparoscopic surgery procedure seems to be a less invasive alternative to open placement of gastrostomy. This approach has the possible advantages of reduced post-operative pain, faster return to normal function, reduced port site complications, improved cosmesis and better patient satisfaction.
Postoperative complications in children undergoing video-assisted gastrostomy tube placement correlated to their age and diagnosis  [cached]
Helén Sj?wie,Malin Melberg,Einar Arnbj?rnsson
Gastroenterology Insights , 2012, DOI: 10.4081/gi.2012.e5
Abstract: Gastrostomy tube placements in children are associated with frequent postoperative complications. Children with gastrostomy tubes are frequent visitors to the emergency department and outpatient clinic. The aim of this study was to determine the incidence of postoperative gastrostomy complications and disclose if these were correlated to the patients’ age and diagnosis. This is a prospective study of children who had undergone laparoscopic gastrostomy tube placement from June 2006 through March 2011. Patient demographics, comorbidities, and complications were collected. Data were analyzed by Fisher’s exact test. P<0.05 is considered significant. One hundred and sixty-two children were evaluated, with the majority of patients < 2 years of age (106/162). All the patients had undergone laparoscopic-assisted gastrostomy with double U-stitch technique. Granulation tissue, vomiting, infection, leakage were the most common postoperative complications. The majority of patients with these complications had full resolution by the sixth postoperative month. Tube dislodgement was a complication, occurring 16 times in 14 of the patients (10%) and resulting in 16 emergency department (ED) visits. Diagnoses were predictive of complications, and age and gender were not. Granulation tissue, vomiting, infection, leakage and tube dislodgement are complications after gastrostomy placement in children. The age of the child, was not predictive of complications but children with congenital cardiac malformation and malignant diseases had more frequent postoperative complications.
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