Pediatric laparoscopic gastrostomy with fasteners: A technique to decrease surgical site infection.

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Introduction: Laparoscopic gastrostomy (LG) is a popular technique for establishing long-term enteral access in children. During LG, there are several methods available to create a secure gastropexy, including the subcuticular (SC) and T-fastener (TF) techniques. The purpose of this study is to compare local wound infections between these two techniques. Methods: A retrospective review was performed of all pediatric patients who underwent LG between June 2012 and June 2018 at a tertiary care children’s hospital. Patients were divided into two cohorts based on use of the SC or TF gastropexy techniques. Patient characteristics, operative details, wound complications, and outcomes were compared between cohorts using descriptive statistics, Wilcoxon’s rank-sum test, Pearson’s chi-square test, and odds ratios with 95% confidence intervals; exact computations were used for the latter two methods when appropriate. Results: In total, 119 patients underwent LG: 81 (68%) in the SC group and 38 (32%) in the TF group. Patient demographics and comorbidities were similar between groups. Median operative times were similar (39.5 min-SC vs 37 min-TF, P=0.49). At 30 days, SC patients had an increased incidence of surgical site infection (SSI) when compared to the TF group (20% vs 0%, P=.006). All SC patients with an SSI required antibiotics, and 19% of these patients had a concurrent abscess requiring incision and drainage. Long-term (30-90 days), there may be a persistent increase in the incidence of SSI in the SC group [11% vs 4%, P=0.44, OR=3.2, 95% CI: (0.39, 147)]. There were no differences in early tube dislodgement rates [14% vs 17%, P=0.66, OR = 0.78, 95% CI: (0.24, 2.84)], and no patients required operative replacement. Conclusion: Utilizing T-fasteners during LG creates a secure gastropexy with a decreased incidence of SSI when compared to a subcuticular technique. Pediatric surgeons should consider this technique during LG placement in children.





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