N. C. Wilson1, N. Weber2, N. Keime3, N. Becher2, S. Tong3, C. Prendergast2, A. M. Kulungowski2, J. Diaz-Miron2, S. N. Acker2 1Creighton University Medical Center, Omaha, NE, USA 2Children’s Hospital Colorado, Aurora, CO, USA 3University Of Colorado Denver, Aurora, CO, USA
Introduction: There are a variety of surgical techniques used to secure the stomach to the abdominal wall during gastrostomy tube (GT) placement. Previous data demonstrate increased risk of cellulitis related to choice of fascial suture type. We aimed to determine if the choice of fascial suture impacted rates of common complications after GT placement.
Methods: We conducted a single-center retrospective review of children who underwent GT placement from 1/2018 – 5/2023. Patients who had a concomitant procedure labeled as wound class II (clean-contaminated, e.g., colectomy or small bowel resection) or greater were excluded. Subjects were matched 2:1 by suture type beginning with the most recent cases. Additional patients were selected from earlier dates to provide longitudinal representation. From these, a convenience sample was generated. Data collected included patient characteristics and clinical course. Outcomes evaluated included: cellulitis, tube dislodgement, granulation tissue, ED visits, readmission, and reoperation. Comparisons were made based on type of fascial suture used, either a polyglactin, braided absorbable suture or poliglecaprone, absorbable monofilament suture. Suture choice was based on surgeon preference.
Results: 184 patients were included; 122 in the braided group (66%). There were no differences in patient demographics including age in months (median 12.8), weight for age Z-score, sex (50.5% male), race (72.9% white), ethnicity (64.1% not Hispanic or Latinx), insurance status (67.2% Government), or primary language (93.2% English). Rate of granulation tissue at 2 weeks (p = 0.88) and 6 months postoperatively (p = 0.53) did not differ between groups. Number of granulation tissue events did not differ (median 1, IQR 0-1.5; p = 0.63). There was no difference in rates of cellulitis (p = 0.49) or tube dislodgement (p = 0.55) at 2 weeks. There were no differences in number of postoperative phone calls to the pediatric surgery clinic within 2- and 8-weeks post op. ED visits and readmissions within 30 days and 8 weeks did not differ. Clinical course, including postoperative date of discharge; hospital length-of-stay; and anesthetic and intraoperative complications were not significantly different. There were no differences in rates of gastrostomy tube removal and need for subsequent gastrocutaneous fistula (GCF) closure. See Table 1.
Conclusion: Fascial suture type does not significantly impact the rate of postoperative complications including rates of cellulitis, granulation tissue, tube dislodgement, number of phone calls to the clinic, or subsequent need for GCF closure, following GT placement in pediatric patients.
