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Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study

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Abstract

Introduction

A gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. However, data on efficacy, perioperative complications and postoperative gastroesophageal reflux (GER) after laparoscopic gastrostomy (LAG) placement is limited.

The aim of this study is to evaluate long-term efficacy and adverse events after LAG in a large cohort and determine whether routine preoperative 24-h pH monitoring should be used to predict postoperative GER.

Method

A retrospective observational cohort study was performed including 300 patients (75 % neurologically impaired) that underwent LAG.

Results

After a median follow-up of 2.63 years, feeding was successful in 95.9 % of patients. Weight-for-length z-scores significantly increased (p < 0.0005). Major complications were seen in only 6 patients (2.0 %), but minor complications occurred frequently (73.6 %). Overall incidence of GER remained unchanged after LAG. Sensitivity and specificity of preoperative pH monitoring were 17.5 and 76.9 %, respectively.

Conclusion

LAG placement in pediatric patients leads to successful feeding in 96 % of patients and serious adverse events are rare. However, the minor complication rate is high. Overall incidence of GER does not increase after LAG. Preoperative 24-h pH monitoring is not a reliable tool to predict postoperative GER. This invasive investigation technique should therefore not be routinely performed.

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Acknowledgments

F.A. Mauritz is supported by a Wilhelmina Children’s Hospital Grant and NutsOhra. No other sources of support were used.

Disclosures

J. Franken, F.A. Mauritz, N. Suksamanapun, C.C.C. Hulsker, D.C. van der Zee, and M.Y.A. van Herwaarden-Lindeboom have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands

    Josephine Franken, Femke A. Mauritz, Nutnicha Suksamanapun, Caroline C. C. Hulsker, David C. van der Zee & Maud Y. A. van Herwaarden-Lindeboom

  2. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

    Femke A. Mauritz

  3. Department of Pediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Nutnicha Suksamanapun

Authors
  1. Josephine Franken
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  2. Femke A. Mauritz
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  3. Nutnicha Suksamanapun
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  4. Caroline C. C. Hulsker
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  5. David C. van der Zee
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  6. Maud Y. A. van Herwaarden-Lindeboom
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Corresponding author

Correspondence to Maud Y. A. van Herwaarden-Lindeboom.

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Franken, J., Mauritz, F.A., Suksamanapun, N. et al. Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study. Surg Endosc 29, 1545–1552 (2015). https://doi.org/10.1007/s00464-014-3839-5

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  • DOI: https://doi.org/10.1007/s00464-014-3839-5

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