Pediatric surgical gastrostomy revision in the modern era, patterns, and potential modifiable factors: A retrospective analysis.

Abstract

Objectives: Long-term use of gastrostomy tubes (G-Tubes) presents a potential risk for surgical gastrostomy revision (SGR) with re-siting of the tract. This study describes the patterns of SGR to ascertain if this may be a potentially modifiable event. We hypothesize that gradual tract compression or migration may contribute to the need for SGR.

Methods: A retrospective review of patients who had SGR from January 2010 to January 2024 was conducted. Data collected included demographics, anthropometric measurements at SGR, diagnosis at initial gastrostomy placement (IGP), indication for SGR, G-Tube length pre- and post-SGR. Descriptive and inferential statistics were applied.

Results: We included 111 patients. The median age at IGP was 0.3 years (interquartile range [IQR]: 0-2 years). The median age at SGR was 5 years (IQR: [1.6, 15.7]; range: 0-36 years). Overlapping indications for SGR included: excessive leaking in 77%, gastric prolapse in 36%, and tract migration to the costal margin with somatic growth in 33%. Tract compression was contributory to SGR as the G-Tube length had to be increased by an average of 0.7 cm in 75% of cases at SGR. A higher G-Tube length at SGR was positively correlated with higher weights (r = 0.78, p < 0.0001) and older age (r = 0.68, p = 0.0001).

Conclusion: Migration toward the costal margin over years due to growth was documented; hence, locating the gastrostomy as inferior as possible at IGP is supported. Furthermore, anticipatorily increasing the G-Tube length to prevent tract compression due to growth over the years is strongly supported as a modifiable factor to avoid reoperation.