Gastrostomy complications in infants and children: a comparative study.

Purpose: Gastrostomy is a commonly undertaken procedure in children. Methods for gastrostomy insertion have evolved and laparoscopy is commonly used to aid its insertion. The aim of this study is to review the outcome and complications of laparoscopic-assisted gastrostomy insertion.

Methods: A retrospective case note review of children undergoing gastrostomy insertion by a single surgeon from 1999 to 2007.

Results: 114 children underwent gastrostomy insertion, 68 males and 46 females, with a median age of 55 months (IQR 28-149 months). The majority were neurologically impaired. 98 underwent laparoscopic-assisted PEG (86%), 1 was converted to open procedure (0.9%) and 16 had standard PEG (14%). Median follow-up was 10.5 months with 90 children having their original gastrostomy changed to a button at a median interval of 7.4 months. Complications observed included new or deteriorating gastro-oesophageal reflux (GOR) (n = 16), infection (n = 9), granulation tissue (n = 11), tube dislodgement (n = 2) and intra-abdominal leakage of feed (n = 2). There were two gastrocolic fistulae which occurred in the standard PEG group.

Conclusion: The inadvertent formation of a gastrocolic fistula was avoided with the use of laparoscopy to aid PEG insertion.