title: Subcutaneous fixation of gastrostomy tube is superior to temporary fixation.
abstract: OBJECTIVE
  The placement of gastrostomy tubes (GTs) in infants and children to provide enteral access over the past decade has shifted toward a minimally invasive, safer direction with the development of various new techniques. We have developed a modified technique, utilizing subcutaneous (S.C.) tunneling stay sutures to prevent complications, such as GT dislodgment and wound infection. The aim of this study was to identify and describe complications of the modified procedure and compare it with the standard laparoscopic GT placement.
  
  
  METHODS
  A retrospective 4-year review of 153 patients who underwent laparoscopic GT placement was conducted. Eighty-nine patients underwent the modified S.C. tunneled technique, and 64 patients had standard U-stitch with temporary fixation.
  
  
  RESULTS
  The overall complication rate was significantly higher with the temporary fixation group (20%) versus the modified technique group (2.5%). Six patients from the temporary group and 2 patients from the modified group developed cellulitis. Seven patients underwent reoperation secondary to GT dislodgment in the temporary group. No patients were identified with tube-related pressure necrosis or procedure-related deaths.
  
  
  CONCLUSIONS
  S.C. placement of stay sutures in the modified technique is associated with a lower complication rate than temporary fixation. The modified technique should be the preferred approach when performing laparoscopic GT insertion.
authors.affiliation: Department of Pediatric Surgery, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA. mikaelpetrosyanmd@mac.com
authors.forename: Mikael
authors.initials: M
authors.lastname: Petrosyan
authors.forename: Catherine
authors.initials: C
authors.lastname: Hunter
authors.forename: Joaquin
authors.initials: J
authors.lastname: Estrada
authors.forename: Yigit
authors.initials: Y
authors.lastname: Guner
authors.forename: Faisal
authors.initials: F
authors.lastname: Qureshi
authors.forename: James
authors.initials: J
authors.lastname: Stein
authors.forename: Henri R
authors.initials: HR
authors.lastname: Ford
authors.forename: Kasper
authors.initials: K
authors.lastname: Wang
authors.forename: Nam
authors.initials: N
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome