Video assisted gastrostomy in children

University dissertation from Lund University, Faculty of Medicine

Abstract: Children with severe diseases can be provided nutritional support through a gastrostomy if needed. At the Department of Paediatric Surgery in Lund we have used the Video Assisted Gastrostomy (VAG) procedure since 1994 when establishing gastrostomies. In this thesis, children with different diseases, who all had undergone the VAG procedure, were studied in five different clinical studies. Postoperative complications were collected and validated. We have not seen any major complications associated with the surgical procedure in any of the studies, such as peritonitis due to leakage of gastric contents into the abdominal cavity, tube dislodgement, gastro-colic fistula or severe haemorrhage. Complications discussed below are therefore to be characterized as minor and include local infections, leakage and development of granulation tissue. Based on our studies, we have found that the VAG procedure is a safe method even when performed in children less than 1 year of age, and that these patients had a significant weight gain 6 months postoperatively (Paper I). Children with malignant diseases and treated with chemotherapy, did not have a higher incidence of postoperative complications after the VAG procedure compared to children with neurologic impairment. In the patients with postoperative complications, such as granuloma formation and infection, we did not find a correlation between these complications and the timing of the administration of the chemotherapy treatment (Paper II). Children with a previously placed ventriculo-peritoneal shunt (VPS) due to underlying neurosurgical diseases, did not present with any serious intra-abdominal complications, VPS or central nervous system infections after a VAG procedure. Concerning minor complication rates, no differences were seen between the children with neurosurgical diseases with a VPS and the control group including children with neurological impairment without a VPS (Paper III) We developed, and thereafter used, a new suturing technique when adapting the ventricle to the abdominal wall when performing a VAG procedure in children. We noticed a significant decrease in the incidence of granulation tissue development in the group where the new suture was used, coined “the continuous double U-stitch suture”, compared to the group of children in whom we had used our previously suturing technique, the purse-string suture (Paper IV). Vomiting is a common symptom in children with severe diseases and is most frequent in those with neurological impairment. The VAG procedure does not lead to increased vomiting in children. In children with vomiting symptoms before a VAG procedure, 78% had persisting symptoms six months after surgery (Paper V)