title: U-stitch laparoscopic gastrostomy technique has a low rate of complications and allows primary button placement: experience with 461 pediatric procedures.
abstract: BACKGROUND
  Gastrostomy tube placement is among the most common gastrointestinal procedures performed in children. The U-stitch laparoscopic technique allows primary button placement and the advantages of laparoscopy. The purpose of this study was to quantify the completion rate and the occurrence of complications in a large single-institution experience.
  
  
  METHODS
  All laparoscopic gastrostomy procedures between April 2000 and May 2005 were reviewed. Complications that required operative treatment or hospital readmission were classified as early (<90 days) or late (> or =90 days).
  
  
  RESULTS
  Laparoscopic gastrostomies were created in 461 patients during the study period with primary buttons being placed in 444 (96%). No procedure-related deaths occurred. Early complications included: reoperation secondary to tube dislodgement in 7 patients (1.5%), herniation of omentum postoperatively in 3 patients (0.6%), and development of granulation tissue or everted gastric mucosa requiring excision in 13 patients (3.2%). Late complications occurred in 8 patients (1.7%), with three (0.7%) requiring revision of the gastrostomy due to local site problems. Five patients (1.1%) had intraperitoneal placement of tubes during attempted replacement after 90 days. Age, infancy, and neurological impairment were not associated with a higher rate of complications.
  
  
  CONCLUSIONS
  The U-stitch gastrostomy technique is safe and allows primary button placement in infants and children. Its complication rate compares favorably to other reported gastrostomy techniques.
authors.affiliation: Division of Pediatric Surgery, University of Alabama-Birmingham, Birmingham, Alabama, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Aprahamian
authors.forename: Traci L
authors.initials: TL
authors.lastname: Morgan
authors.forename: Carroll M
authors.initials: CM
authors.lastname: Harmon
authors.forename: Keith E
authors.initials: KE
authors.lastname: Georgeson
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome