title: Modified approach to laparoscopic gastrostomy tube placement minimizes complications.
abstract: BACKGROUND
  Complications from previously published techniques for laparoscopic gastrostomy tube placement include skin pressure necrosis and extraluminal migration. We developed a modified technique utilizing subcutaneous stay-sutures in order to minimize such complications. This study aimed to identify, quantify, and characterize complications of the modified procedure.
  
  
  METHODS
  Charts were reviewed of all pediatric patients undergoing laparoscopic gastrostomy tube placement over 79 months. Complications requiring reoperation, readmission, or outpatient treatment were identified and classified as major or minor.
  
  
  RESULTS
  Laparoscopic gastrostomy tubes were placed via modified procedure in 82 patients. Two (2.44%) high-risk patients with significant comorbidities were readmitted for wound infections, two (2.44%) received outpatient antibiotics for cellulitis, and three (3.66%) developed stitch abscesses which resolved with local care. None of the patients had initial intraperitoneal placement, intraperitoneal location upon tube replacement, extraluminal migration, tube-related pressure necrosis, or procedure-related death.
  
  
  CONCLUSIONS
  Subcutaneous placement of absorbable stay-sutures for laparoscopic gastrostomy tubes offers significant benefits. We eliminated complications associated with presence of external sutures, as well as those associated with early suture removal. This modified technique avoids additional visits for suture removal, avoids pressure necrosis from external stay-sutures, and provides improved adherence of stomach to abdominal wall, thereby preventing extraluminal migration and intraperitoneal tube replacement.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Minnesota, 420 Delaware Ave SE, Mayo Mail Code 195, Minneapolis, MN 55455, USA. rose0437@umn.edu
authors.forename: Mara B
authors.initials: MB
authors.lastname: Antonoff
authors.forename: Donavon J
authors.initials: DJ
authors.lastname: Hess
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Saltzman
authors.forename: Robert D
authors.initials: RD
authors.lastname: Acton
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult