Antonoff Mara B, Hess Donavon J, Saltzman Daniel A, Acton Robert D
Division of Pediatric Surgery, Department of Surgery, University of Minnesota, 420 Delaware Ave SE, Mayo Mail Code 195, Minneapolis, MN 55455, USA.
Pediatr Surg Int. 2009 Apr;25(4):349-53. doi: 10.1007/s00383-009-2340-z. Epub 2009 Feb 28.
Complications from previously published techniques for laparoscopic gastrostomy tube placement include skin pressure necrosis and extraluminal migration. We developed a modified technique utilizing subcutaneous stay-sutures in order to minimize such complications. This study aimed to identify, quantify, and characterize complications of the modified procedure.
Charts were reviewed of all pediatric patients undergoing laparoscopic gastrostomy tube placement over 79 months. Complications requiring reoperation, readmission, or outpatient treatment were identified and classified as major or minor.
Laparoscopic gastrostomy tubes were placed via modified procedure in 82 patients. Two (2.44%) high-risk patients with significant comorbidities were readmitted for wound infections, two (2.44%) received outpatient antibiotics for cellulitis, and three (3.66%) developed stitch abscesses which resolved with local care. None of the patients had initial intraperitoneal placement, intraperitoneal location upon tube replacement, extraluminal migration, tube-related pressure necrosis, or procedure-related death.
Subcutaneous placement of absorbable stay-sutures for laparoscopic gastrostomy tubes offers significant benefits. We eliminated complications associated with presence of external sutures, as well as those associated with early suture removal. This modified technique avoids additional visits for suture removal, avoids pressure necrosis from external stay-sutures, and provides improved adherence of stomach to abdominal wall, thereby preventing extraluminal migration and intraperitoneal tube replacement.
先前已发表的腹腔镜胃造口管置入技术的并发症包括皮肤压迫坏死和管腔外移位。我们开发了一种利用皮下留置缝线的改良技术，以尽量减少此类并发症。本研究旨在识别、量化并描述改良手术的并发症。
回顾了79个月内所有接受腹腔镜胃造口管置入术的儿科患者的病历。确定需要再次手术、再次入院或门诊治疗的并发症，并将其分类为严重或轻微并发症。
82例患者通过改良手术置入了腹腔镜胃造口管。两名（2.44%）患有严重合并症的高危患者因伤口感染再次入院，两名（2.44%）因蜂窝织炎接受门诊抗生素治疗，三名（3.66%）出现缝线脓肿，经局部护理后痊愈。所有患者均未出现初始腹腔内放置、更换造口管时腹腔内位置、管腔外移位、造口管相关压迫坏死或手术相关死亡。
腹腔镜胃造口管采用皮下放置可吸收留置缝线有显著益处。我们消除了与外部缝线存在相关的并发症，以及与早期缝线拆除相关的并发症。这种改良技术避免了额外的拆线就诊，避免了外部留置缝线引起的压迫坏死，并改善了胃与腹壁的粘连，从而防止管腔外移位和腹腔内更换造口管。
