Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
University of Miami Miller School of Medicine, Miami, Florida, USA.
J Laparoendosc Adv Surg Tech A. 2021 Dec;31(12):1376-1383. doi: 10.1089/lap.2021.0347. Epub 2021 Nov 5.
There are few nationwide studies comparing outcomes of open, laparoscopic (LAP), and percutaneous endoscopic (PEG) gastrostomy tube (GT) placement in the pediatric population. The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients ≤18 years (excluding newborns) who underwent GT placement. Demographics, hospital characteristics, and outcomes were compared by the GT approach. There were 3278 patients (41% female, age 3 ± 5 years) identified who underwent GT placement (40% open versus 32% PEG versus 28% LAP). Following an open approach, there were higher rates of GT-related complications (10% versus 4% LAP versus 3% PEG) and postoperative gastrointestinal issues (24% versus 12% LAP versus 9% PEG) on index hospitalization, both < .001. Readmission within 30 days and 1 year were 18% and 43%, respectively. Overall readmission rates were not affected by the GT approach (44% open versus 44% LAP versus 43% PEG, = .773). However, readmission for GT-related complications was the lowest following the LAP approach (<0.3% versus 2% open versus 2% PEG, < .001). When those who also underwent fundoplication were excluded, conversion to gastrojejunostomy or jejunostomy (GJ/J) on readmission was higher following open and PEG approaches (4% open versus 2% PEG versus 0% LAP, = .039). Compared with PEG gastrostomy and open gastrostomy, LAP GT placement appears to have lower index complications and reoperation rates, and at least comparable readmission outcomes. Despite these advantages, LAP GT placement remains underutilized.
在儿科人群中，比较开放手术、腹腔镜（LAP）和经皮内镜（PEG）胃造口管（GT）放置术的结局的全国性研究很少。使用 2010 年至 2014 年全国再入院数据库，确定接受 GT 放置术的≤18 岁（不包括新生儿）患者。通过 GT 途径比较人口统计学、医院特征和结局。确定 3278 名患者（41%为女性，年龄 3±5 岁）接受 GT 放置术（40%为开放术式，32%为 PEG 术式，28%为 LAP 术式）。采用开放术式，索引住院期间 GT 相关并发症（10%比 LAP 术式的 4%和 PEG 术式的 3%）和术后胃肠道问题（24%比 LAP 术式的 12%和 PEG 术式的 9%）的发生率较高，均<0.001。30 天和 1 年的再入院率分别为 18%和 43%。总体再入院率不受 GT 途径的影响（开放术式为 44%，LAP 术式为 44%，PEG 术式为 43%，=0.773）。然而，LAP 术式后 GT 相关并发症的再入院率最低（<0.3%比开放术式的 2%和 PEG 术式的 2%，<0.001）。当排除那些也接受胃底折叠术的患者时，开放术式和 PEG 术式的再入院时更倾向于转为胃肠造口术或空肠造口术（GJ/J）（开放术式为 4%，PEG 术式为 2%，LAP 术式为 0%，=0.039）。与 PEG 胃造口术和开放胃造口术相比，LAP GT 放置术具有较低的指数并发症和再次手术率，并且至少具有可比的再入院结局。尽管有这些优势，LAP GT 放置术的应用仍然不足。
