LAPAROSCOPIC GASTROSTOMY BUTTON PLACEMENT USING TRANSFASCIAL SUTURES

Objectives: Minimally invasive placement of gastrostomy button (G-button) has received wider recognition in last three decades. Various techniques have been described in the pediatric surgery literature describing laparoscopic placement. One such technique is the U-stitch technique which utilizes direct visualization of intraperitoneal anatomy to place a G-button into the stomach which remains temporarily fixed to the anterior abdominal wall. Given temporary fixation, dislodgement of the g-button remained a concern and oftentimes warranted operative exploration. A modification of this technique involved fixation of the stomach permanently to the anterior abdominal wall. This was done subcutaneously using absorbable sutures. Subcutaneous placement of sutures makes patient prone to wound infections. Transfascial fixation of stomach avoids introduction of suture material into the subcutaneous tissue, thus theoretically decreasing the chances of wound infection. The purpose of this study is to evaluate outcomes of our laparoscopic G-button placement with transfascial sutures.

Methods: IRB approval was obtained. A total of 100 consecutive pediatric patients (Age < 3 years) who underwent laparoscopic G-button placement between 2016-2020 were included in the study. A retrospective review was conducted, and the following data was recorded: Age; Indication for G-button placement; Surgical site infection at Post-operative-day (POD) 1, and POD7; G-button dislodgement at POD1, POD1- POD7, and POD7-POD30.

Results: The most common indication for G-button placement in our patients was inability to tolerate PO feeds. None of the patients developed an SSI at POD1 and POD7. G-button dislodgement incident rate was zero at POD1. Further, none of our patients experienced a dislodgement between POD1-POD30.

Conclusion: Transfascial fixation of stomach for G-button placement reduces the risk of wound infection following minimally invasive techniques and decreases the incidence of G-button dislodgment.