Page 53 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

pathological reflux was not identified and both patients were operated based on GER symptoms.
DisCUssion
This large, retrospective long-term cohort study showed that LGP in children is a successful treatment in providing a long-lasting and safe route for enteral tube feeding. No study has yet reported on the long-term efficacy of pediatric gastrostomy placement.
In nearly all patients (99.3%), gastrostomy placement could be completed laparoscopically. Also, LGP enabled successful enteral feeding in nearly all pediatric patients (95.9%). Nearly 16% of patients successfully returned to complete oral feeding. Most of these patients were neurologically normal. In only 4.1% of patients an alternative feeding route was necessary to safeguard sufficient enteral feeding after initial LGP. Most of these patients were neurologically impaired and suffered from significant comorbidity consisting of congenital cardiac deformities and/or respiratory problems.
Nutritional status improved significantly after LGP, as weight-for-height z-scores significantly increased compared to the normal mean score of the reference population. Height-for- age z-scores remained similar. However, previous studies on catch-up growth in children recovering from malnutrition showed that weight-for-height measures are the only reliable indicator for improvement of nutritional status, as height-for-age measures are generally more delayed during catch-up growth.20,21 Moreover, the majority of included patients is neurologically impaired and these children have impaired linear growth regardless of improvement of nutritional status. 7
Evaluation of adverse events showed us that LGP is a safe procedure, since the number of major complications is low (2.0%). This is in line with previous publications.22,23 Procedure- related mortality did not occur, although the overall mortality rate was reasonably high (8.7%). Mortality was due to deterioration of the underlying disorder in all cases.
In contrast to the low rate of major complications, minor complications occurred in the majority of patients after LGP. Minor complications often result in increased health care utilization because of significant discomfort and frequent hospital consultations 11 and should therefore be taken into account when LGP is considered in a pediatric patient. Hypergranulation, gastrostomy site infection, leakage of gastric contents and gastrostomy tube dislodgement were the most frequently reported minor complications. Most studies on adverse events after gastrostomies in pediatric patients reported lower rates of
Chapter 3
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