Tazi Kaoutar, Kotilea Kallirroi, Dassonville Martine, Bontems Patrick
From the Paediatric Gastroenterology Department, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
Paediatric Surgery Department, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
JPGN Rep. 2023 May 9;4(2):e316. doi: 10.1097/PG9.0000000000000316. eCollection 2023 May.
Gastrostomy placement is a standard procedure for children requiring enteral feeding for more than 3-6 weeks. Various techniques have been described (percutaneous endoscopic, laparoscopy, and laparotomy), and many complications have been reported. In our center, gastrostomy placement is performed either percutaneously by pediatric gastroenterologists, by laparoscopy/laparotomy by the visceral surgery team, or jointly, that is laparoscopic-assisted percutaneous endoscopic gastrostomy. This study aims to report all complications and identify risk factors and ways to prevent them.
This is a monocentric retrospective study including children younger than 18 years who underwent gastrostomy placement (percutaneous or surgical) between January 2012 and December 2020. Complications that occurred up to 1 year after placement were collected and classified according to their time of onset, degree of severity, and management. A univariate analysis was conducted to compare the groups and the occurrence of complications.
We established a cohort of 124 children. Sixty-three (50.8%) presented a concomitant neurological disease. Fifty-nine patients (47.6%) underwent endoscopic placement, 59 (47.6%) surgical placement, and 6 (4.8%) laparoscopic-assisted percutaneous endoscopic gastrostomy. Two hundred and two complications were described, including 29 (14.4%) major and 173 (85.6%) minor. Abdominal wall abscess and cellulitis were reported 13 times. Patients who underwent surgical placement presented more complications (major and minor combined) with a statistically significant difference compared with the endoscopic technique. Patients with a concomitant neurological disease had significantly more early complications in the percutaneous group. Patients with malnutrition had significantly more major complications requiring endoscopic or surgical management.
This study highlights a significant number of major complications or complications requiring additional management under general anesthesia. Children with a concomitant neurological disease or malnutrition are at greater risk of severe and early complications. Infections remain a frequent complication, and prevention strategies should be reviewed.
胃造口术置入是需要肠内喂养超过3至6周的儿童的标准手术。已描述了多种技术（经皮内镜、腹腔镜和剖腹手术），并且报告了许多并发症。在我们中心，胃造口术置入由儿科胃肠病学家经皮进行，由内脏外科团队通过腹腔镜/剖腹手术进行，或者联合进行，即腹腔镜辅助经皮内镜胃造口术。本研究旨在报告所有并发症，并确定危险因素及预防方法。
这是一项单中心回顾性研究，纳入了2012年1月至2020年12月期间接受胃造口术置入（经皮或手术）的18岁以下儿童。收集置入后1年内发生的并发症，并根据其发病时间、严重程度和处理方式进行分类。进行单因素分析以比较各组及并发症的发生情况。
我们建立了一个124名儿童的队列。63名（50.8%）患有伴发神经系统疾病。59例患者（47.6%）接受内镜置入，59例（47.6%）接受手术置入，6例（4.8%）接受腹腔镜辅助经皮内镜胃造口术。共描述了202例并发症，包括29例（14.4%）严重并发症和173例（85.6%）轻微并发症。腹壁脓肿和蜂窝织炎报告了13次。接受手术置入的患者出现更多并发症（严重和轻微并发症合计），与内镜技术相比有统计学显著差异。伴发神经系统疾病的患者在经皮组中早期并发症明显更多。营养不良的患者有更多需要内镜或手术处理的严重并发症。
本研究突出了大量严重并发症或需要在全身麻醉下进行额外处理的并发症。患有伴发神经系统疾病或营养不良的儿童发生严重和早期并发症的风险更高。感染仍然是常见并发症，应重新审视预防策略。
