Page 47 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

the fascia of the abdominal wall with Vicryl sutures in four directions. The stomach was insufflated by the anesthesiologist. With clear laparoscopic view a needle was inserted into the stomach. A peel-away dilator was placed using the Seldinger technique followed by introduction of a gastrostomy catheter. Finally, the balloon of the catheter was inflated with sterile water. Feeding through the gastrostomy, with half of the normal feeding regimen, was initiated on the first postoperative day. Full enteral feeding was administered on the second day after surgery.
Clinical assessment
The following outcomes were evaluated:
(1) efficacy of LGP, determined by conversion rate, successfull feeding and nutritional
status and
(2) adverse events, defined as major and minor complications, reinterventions and GER
symptoms.
Successful feeding; defined as:
(1) complete enteral feeding via gastrostomy;
(2) return to complete oral feeding after gastrostomy feeding or (3) a combination of oral feeding and feeding via gastrostomy.
Alternative methods of feeding, such as feeding via a nasogastric tube, nasoduodenal tube, gastrojejunostomy, jejunostomy or total parenteral nutrition, were considered unsuccessful.
Nutritional status
Weight and height measurements were converted to weight-for-height and height-for- age z-scores based on the Netherlands Organization for Applied Scientific Research (TNO) growth standards. 17 Z-scores allow comparison of an individual’s weight or height, adjusting for age and sex relative to a reference population, expressed in standard deviations from the reference mean.
Adverse events
Major complications were defined as procedure-related death, postoperative dehiscence of the stomach wall, intraoperative or postoperative bleedings, perforation of adjacent organs, acute intestinal obstruction, volvulus and omental herniation. Minor complications were defined as hypergranulation at the gastrostomy insertion requiring treatment with silver nitrate or surgical excision, ectopic gastric mucosa requiring surgical excision, stomal infection requiring treatment with antibiotics or antifungal medication, gastric content leakage at the gastrostomy insertion, dislodgement or obstruction of the catheter requiring
Chapter 3
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