Page 130 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

In chapter 3 a large retrospective survey was described including 300 children who underwent laparoscopic GP with a median follow-up time of 2.63 years. Analysis of efficacy showed that GP was successful in providing a long-lasting route for enteral tube feeding. In 99.3% of patients GP was completed laparoscopically. Only 4.1% of patients required an alternative method of feeding after initial GP (example given a gastrojejunostomy). Nutritional status improved after GP, as weight-for-height z-scores significantly increased.
Evaluation of adverse events showed that laparoscopic GP was a relatively safe procedure, with no procedure related mortality and a major complication rate of 2.0%. However, minor complications occurred very frequently: in 221 patients (out of 300; 73.7%), a total of 408 minor complications occurred, mainly including hypergranulation, infection, leakage and dislodgement of the catheter. Fourty-eight reinterventions were required, either in the operating theatre or at the radiology department.
Gastrostomy-related complications were also shortly discussed in chapter 6, in which questionnaires with gastrostomy-related questions were filled out by caregivers of 150 children after undergoing laparoscopic GP (in addition to health-related quality of life (HRQoL) questionnaires). Minor complications rates were comparable.
iii. Gastrointestinal effects
Gastric emptying
In 15–25% of patients a gastrostomy fails, characterized by intolerance of feeding with excessive vomiting and/or leakage of gastric contents at the gastrostomy site. 10 These complications might be associated with changes in gastric motility after GP. No prospective studies had been performed analyzing gastric emptying (GE) rates before and after GP.
In chapter 4 a prospective, longitudinal cohort study was presented on 34 patients who underwent a 13C gastric emptying breath test before and 3 months after laparoscopic GP. Gastric half-emptying time significantly increased from the 57th percentile to the 79th percentile after gastrostomy (p<0.001). Fifty percent of patients with normal preoperative GE (13 out of 26) developed delayed GE (>95th percentile) after GP (p=0.01). The delay in GE was similar for neurologically impaired and neurologically normal children. Seventy-five percent of patients with leakage and/or feeding intolerance after GP showed delayed GE on the postoperative test. No predictors of gastrostomy failure could be identified.
Gastroesophageal reflux
The development of GER is a widely discussed complication of GP, but current evidence has been of low quality and with inconsistent results. 11
128