Page 31 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Two studies reported on cases of non-closure of the gastrostomy site after removal of the catheter requiring surgical closure. 16,17 The RR of non-closure in children who underwent PEG was 0.94 compared to those who underwent LGP. However, meta-analysis did not identify a statistically significant difference (p = 0.92).
Finally, all included articles reported on the number of reinterventions under general anaesthesia. Patients who received a PEG had a RR of 2.79 (p = 0.0008) compared to patients who received a LGP ; Figure 4. The most frequently reported cause for reintervention in patients with PEG was early tube dislodgement. In patients who underwent LGP the most frequently reported causes were stomal complications (e.g. granulation tissue, erosion, ulceration and non-healing skin). 16
Figure 4. Meta-analysis of all reinterventions requiring general anaesthesia after percutaneous endoscopic gastrostomy versus laparoscopic gastrostomy.
Legend: Risk ratios (RR) are shown with 95% confidence intervals (Mantel–Haenszel random effects model)
To identify possible publication bias, funnel plots were constructed. None of the funnel plots on the primary outcomes showed clear evidence of publication bias, and none of the studies lay outside the 95% CI limits.
secondary outcomes
Two studies provided data on gastric content leakage at the gastrostomy site. 27,28 Patients after PEG had an RR of 3.82 compared to those after LGP of developing gastric content leakage. However, this difference was not statistically significant (p = 0.15).
Only one article reported on risks of stomal infection requiring treatment. 28 This study did not identify a statistically significant difference (0.4% vs.0%, RR=2.87, p=0.52).
Two studies reported data on operating time. 16,17 Akay et al. 16 reported significantly shorter operating time for initial gastrostomy in the PEG group (p = 0.001). Zamakhshary et al. 17 did not identify a difference in operating time (Table 3). In this study, routine postoperative
Chapter 2
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