Page 50 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

The gastrostomy was removed in 34 patients (12.8%). In 30 of these patients removal was possible because of reintroduction of full oral feeds. In the remaining 4 patients, however, removal was due to gastrostomy-related complications, predominantly leakage around the insertion site.
In total, 42 (15.8%) patients were able to return to complete oral feeds. In 12 of these patients the gastrostomy was not yet removed. Reasons to keep the gastrostomy were administering of medication, gastric draining or the anticipation of feeding problems in the near future. Patients with normal neurological development returned to complete oral feeding more frequently compared to patients with neurological impairment (p<0.0005). Eleven patients (4.1%) could not be fed via the gastrostomy and required an alternative method of feeding during follow-up. These were gastrojejunal feeding, nasoduodenal tube feeding, jejunal feeding after laparoscopic jejunostomy placement and total parenteral nutrition. Indications for an alternative route of feeding were excessive leakage of gastric contents at the gastrostomy site or persistent vomiting. In three out of five patients with persistent vomiting a gastric function test was performed which showed severely delayed gastric emptying.
At follow-up, 213 (71.0%) patients still received enteral feeding through their gastrostomy. The majority of these patients (n=127; 42.3%) received successful bolus feeding. In 82 of the patients (27.3%) partial or complete continuous drip-feeding was administered. For four patients, no specific feeding schedule was registered in the patient records.
Nutritional status improved after LGP, as weight-for-height z-scores significantly increased (p<0.0005), although height-for-age z-scores remained similar (p=0.70; Table 2).
Table 2. nutritional status
Legend: 95% CI: 95% confidence interval
Adverse events
A total number of 414 minor and major complications were identified (Table 3). Only 70
patients (26.3%) were completely free of complications. In 25 patients (8.3%) more than three minor complications occurred during follow-up.
Six patients (2%) had a major complication. In four patients a dehiscence of the gastric wall occurred after operation. These patients presented with peritonitis and sepsis and required
Preoperative
At follow-up
p-value
Mean weight-for-height z-score (95% CI)
-0.98 (-1.29 – -0.67)
-0.26 (-0.50 – -0.02)
<0.005
Mean height-for-age z-score (95% CI)
-1.62 (-2.01 - -1.22)
-1.54 (-1.80 – -1.29)
0.70
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