Department of Paediatric and Neonatal Surgery, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, Manchester, United Kingdom.
Department of Paediatric and Neonatal Surgery, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, Manchester, United Kingdom.
J Pediatr Surg. 2021 Aug;56(8):1317-1321. doi: 10.1016/j.jpedsurg.2021.03.055. Epub 2021 Apr 5.
Gastrostomy insertion is a common procedure for paediatric surgeons, with the percutaneous endoscopic gastrostomy (PEG) technique long favoured for its simplicity and speed. However, there is growing evidence to suggest that primary laparoscopic balloon gastrostomy (LBG) insertions may have lower complication rates. This study aimed to determine the relative safety and healthcare resource burden of PEG and LBG.
A retrospective review of all primary gastrostomy insertions (2011-2019). Primary outcome measures included return to theatre for emergency laparotomy and healthcare burden (total gastrostomy-related admissions, length of stay and total theatre utilisation).
338 PEGs and 277 LBGs were inserted with a minimum follow-up period of six months. Following PEG insertion 12/338(3.6%) children required an emergency laparotomy for gastrostomy-related complications. This compared to 2/277(0.7%) following LBG insertion (ARR2.8% (95%CI0.6-5.0), p < 0.0267). When considering all gastrostomy related admissions, there was no significant difference in total theatre utilisation (PEG = 85 [IQR58-117] minutes, LBG = 86 [IQR75-105] minutes, p = 0.12). However, PEGs were found to have an overall longer length of stay 4 [IQR3-7] vs 3 [IQR2-4] days.
LBGs carry a significantly lower rate of major complications and are not associated with an increased healthcare burden. LBG should be considered as the first line method of gastrostomy insertion in children.
胃造口术是小儿外科的常见手术，经皮内镜胃造口术（PEG）因其简单、快速而长期受到青睐。然而，越来越多的证据表明，原发性腹腔镜球囊胃造口术（LBG）的并发症发生率可能较低。本研究旨在确定 PEG 和 LBG 的相对安全性和医疗资源负担。
回顾性分析 2011 年至 2019 年所有初次胃造口术。主要观察指标包括因胃造口相关并发症而返回手术室行急诊剖腹手术的次数和医疗负担（与胃造口相关的总住院人数、住院时间和总手术室使用量）。
共置入 338 例 PEG 和 277 例 LBG，最短随访时间为 6 个月。PEG 置入后 12/338（3.6%）例患儿因胃造口相关并发症需要行急诊剖腹手术，而 LBG 置入后仅 2/277（0.7%）例（ARR2.8%（95%CI0.6-5.0），p<0.0267）。考虑所有与胃造口相关的住院人数，总手术室使用量无显著差异（PEG=85[IQR58-117]分钟，LBG=86[IQR75-105]分钟，p=0.12）。然而，PEG 组的总住院时间明显较长，4[IQR3-7]天 vs 3[IQR2-4]天。
LBG 并发症发生率显著较低，且不会增加医疗负担。LBG 应作为儿童胃造口术的首选方法。
