Primary button gastrostomy: a simplified percutaneous, open, laparoscopy-guided technique.

PURPOSE

Button gastrostomy (BG) insertion has been a secondary procedure after initial open Stamm or percutaneous endoscopic tube gastrostomy. Previous attempts at primary open BG have been limited by the difficulty in bringing the BG "wings" through the abdominal wall. We employed an innovative technique for primary BG, which eliminates many of the disadvantages inherent in tube gastrostomy.

METHODS

From June 1993 to April 1994, primary BG insertion was performed in 34 children, using a silicon BG in a tapered peel-away sheath. Seventeen children had percutaneous endoscopic insertion of the BG. Six (35%) weighed less than 10 kg. Simultaneous laparoscopic guidance was used for percutaneous BG insertion in two children who had had multiple previous abdominal procedures. Open BG was performed during concomitant abdominal procedures in 15 patients and after unsuccessful percutaneous BG in two patients. Twelve patients (71%) weighed less than 10 kg. The standard Stamm technique was used for open BG insertion, and the tapered peel-away sheath was readily brought out through a remote incision in the abdominal wall.

RESULTS

The mean operative time for percutaneous primary BG was 12 minutes from needle insertion (range, 10 to 22 minutes). The mean time until BG feeding was 18 hours after insertion (range, 12 to 48 hours). No serious complications occurred in any of the 34 patients. Follow-up (1 to 10 months) has shown minor tissue reaction, minor leakage, and enthusiastic patient and parent satisfaction.

CONCLUSION

This innovative technique has proven safe and effective and allows for insertion of a skin-level, nonrefluxing, nonreactive, self-retaining feeding device, which eliminates the need for initial open or percutaneous tube gastrostomy and the associated complications. Potential cost savings may result through elimination of secondary button insertion procedures and the radiological studies often used to confirm proper button placement.