Rumbika Savanah, Dantes Goeto, Buchanan Morgan, Byrnes Julia, Harriott Ashley, He Zhulin, Alemayehu Hanna
Department of Surgery, Emory School of Medicine, Atlanta, GA, USA.
Emory University School of Medicine, Emory University, Atlanta, GA, USA.
Pediatr Surg Int. 2024 Dec 12;41(1):25. doi: 10.1007/s00383-024-05888-6.
The optimal technique for gastrostomy tube (GT) placement in pediatric patients remains controversial. Percutaneous endoscopic gastrostomy (PEG) was the preferred approach over open gastrostomy. With the advent of laparoscopy, many advocate for laparoscopic (LAP) placement to avoid potential visceral injury. Additionally, PEG patients may undergo an additional procedure for conversion to a low-profile button. We sought to compare outcomes including complications, need for subsequent procedures, and anesthesia exposure in LAP vs. PEG patients.
Patients (ages 0-18) who underwent GT placement at our pediatric healthcare system between 2018 and 2021 were retrospectively reviewed. Patients were excluded if they underwent fundoplication, gastro-jejunostomy tube placement, open placement, tube placement in concurrence with other intestinal procedures, or failed primary attempt at gastrostomy placement. Data related to demographics and GT placement were recorded. Our primary outcomes were complications, need for subsequent procedures, discrete anesthesia exposures, and cumulative anesthesia exposure. The Wilcoxon rank sum test, Pearson's Chi-squared test, and Fisher's exact test were used to compare characteristics and clinical measurements between PEG and LAP patients.
Six hundred and eighty-eight (688) patients underwent GT placement during the study period, 234 (34.0%) LAP and 454 (66.0%) PEG. LAP patients were younger and weighed less than PEG patients (p = 0.005 and p = 0.002, respectively). Gender distribution, primary insurance status, and ASA (American Society of Anesthesiologists) classification were similar. Within the group excluded, 5 failed PEG placements, while 0 failed LAP GT attempts (p = 0.173). Major complication rates were comparable (1.3% vs. 2.4%, p = 0.401); however, PEG patients were more likely to have skin erythema/local infection (p = 0.006). PEG patients tended toward undergoing subsequent procedures (10.9% vs. 6.5% for LAP, p = 0.061) such as GT revision or conversion to gastro-jejunostomy tube. Additionally, 60.5% of PEG patients required > 2 anesthesia events, most often due to exchange of PEG to a low-profile button, while 93.6% of LAP patients required only one (p < 0.001). Finally, the median total general anesthesia exposure for the PEG group was 75 min (IQR 53-97) and 79 (IQR 67-98) in the LAP group (p = 0.002).
PEG technique is associated with more discrete anesthesia exposures and may also require more subsequent operations related to its placement. However, at our institution, overall major complications are similar in both techniques, while PEG tubes are prone to skin erythema/local infection.
Retrospective Comparative Study, Level III.
小儿患者胃造口管（GT）置入的最佳技术仍存在争议。经皮内镜下胃造口术（PEG）是比开放性胃造口术更可取的方法。随着腹腔镜技术的出现，许多人主张采用腹腔镜（LAP）置入以避免潜在的内脏损伤。此外，PEG患者可能需要额外进行一次手术以转换为低轮廓纽扣式胃造口装置。我们试图比较LAP与PEG患者的结局，包括并发症、后续手术需求及麻醉暴露情况。
对2018年至2021年期间在我们儿科医疗系统接受GT置入的患者（年龄0 - 18岁）进行回顾性研究。如果患者接受了胃底折叠术、胃空肠造口管置入、开放性置入、与其他肠道手术同时进行的造口管置入或初次胃造口术置入失败，则将其排除。记录与人口统计学和GT置入相关的数据。我们的主要结局指标为并发症、后续手术需求、单次麻醉暴露及累积麻醉暴露。采用Wilcoxon秩和检验、Pearson卡方检验和Fisher精确检验比较PEG和LAP患者的特征及临床测量结果。
在研究期间，688例患者接受了GT置入，其中234例（34.0%）为LAP置入，454例（66.0%）为PEG置入。LAP患者比PEG患者年龄更小且体重更轻（分别为p = 0.005和p = 0.002）。性别分布、主要保险状况及美国麻醉医师协会（ASA）分级相似。在排除的组中，5例PEG置入失败，而0例LAP GT置入尝试失败（p = 0.173）。主要并发症发生率相当（1.3%对2.4%，p = 0.401）；然而，PEG患者更易出现皮肤红斑/局部感染（p = 0.006）。PEG患者倾向于接受后续手术（LAP为6.5%，PEG为10.9%，p = 0.061），如GT修复或转换为胃空肠造口管。此外，60.5%的PEG患者需要>2次麻醉事件，最常见的原因是将PEG转换为低轮廓纽扣式胃造口装置，而93.6%的LAP患者仅需要一次（p < 0.001）。最后，PEG组全身麻醉总暴露时间中位数为75分钟（四分位数间距53 - 97），LAP组为79分钟（四分位数间距67 - 98）（p = 0.002）。
PEG技术与更多的单次麻醉暴露相关，并且可能还需要更多与置管相关的后续手术。然而，在我们机构，两种技术的总体主要并发症相似，而PEG管更容易出现皮肤红斑/局部感染。
回顾性比较研究，III级。
