Page 11 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Chapter 1
Gastrostomy placement (GP), in which a feeding tube is surgically inserted into the stomach through an incision in the abdominal wall, is a frequently performed operation in children. GP allows enteral nutritional supplementation in children with insufficient oral intake. GP is generally regarded as a safe procedure to provide enteral tube feeding. However, it may have unanticipated effects on gastrointestinal function and is associated with certain complications. 1,2
indications for GP
GP is performed in a wide spectrum of pediatric patients. In a small number of patients indication for GP is application of medications, for example laxatives in chronic obstipation or ketogenic diet in epilepsy (3-5% of patients in our institution). However, in the majority of children indication for GP is malnutrition in children with severe, chronic feeding problems. Main underlying conditions are neurologic impairment, cystic fibrosis, congenital heart or pulmonary disease, metabolic disease and failure to thrive (without a known diagnosis).3-5
Malnutrition in children
Malnutrition in children is a major threat to pediatric health.6,7 A large survey found a prevalence of malnutrition among admitted children in Dutch hospitals of 19%. 8 In children with known chronic disease, malnutrition was even more common with a prevalence of 51% in academic hospitals and 29% in all hospitals combined.8
The consequences of malnutrition are widespread and may be particularly damaging in early life, since malnutrition leads to impaired growth and development. 9 Decreased muscle strength, including respiratory muscles, results in predisposition to pneumonia. 10 Disturbances in immune function related to malnutrition lead to increased risk of infection. 10 Furthermore, cerebral growth and cognitive development can be impaired. 11
For a long period of time, clinicians accepted malnutrition as part of the child’s disease. However, with the development of tube feeding, poor nutrition has become an alterable component of chronic diseases in children. For short-term enteral feeding, nasogastric tube feeding is often used. However, this comes with several limitations, including nasal discomfort, risk of pulmonary aspiration and frequent blockage or displacement of the catheter. 12 When chronic tube feeding is required, GP can offer a solution.
History of GP
The operative technique of GP was first described as an open procedure by Martin Stamm in 1894. 13 This original technique was performed by laparotomy requiring a considerable operative incision, resulting in significant pain and postoperative hospital stay. 14 In 1980, Gauderer et al. introduced a less invasive technique involving an endoscopic approach to
9