title: Persistent gastrocutaneous fistula: factors affecting the need for closure.
abstract: OBJECTIVE
  The occurrence of gastrocutaneous fistula (GCF) is a well-known complication after gastrostomy tube placement. We explore multiple factors to ascertain their impact on the rate of persistent GCF formation.
  
  
  METHODS
  We retrospectively reviewed patient records for all gastrostomies (GT) constructed at our institution from 2007 to 2011. Association of GCF with method of placement, concomitant fundoplication, neurologic findings, duration of therapy, and demographics was evaluated using logistic regression.
  
  
  RESULTS
  Nine hundred fifty patients had GTs placed, of which 148 patients had GTs removed and 47 (32%) of 148 required surgical closure secondary to persistent GCF. Laparoscopic and open procedures comprised 79 (53%) of 148 and 69 (47%) of 148, respectively. Seventeen (22%) patients in the laparoscopic group developed persistent GCF, compared to 30 (43%) in the open group (P=0.035, OR=2.52). Seventy-one patients had concomitant Nissen fundoplication. Thirty-one (44%) developed GCF, compared to 16 (21%) without a Nissen (P=0.002, OR=4.94). Patients with button in place for 303 days had persistent GCF incidence of 23%, compared to 45% at 540 days (P<0.001, OR=3.51) and 50% at 850 days (P=0.011, OR=4.51). Patients with device placed at 1.8 months of age were more likely to develop GCF compared to those with device placed at 8.9 months of age (P=0.017, OR=2.35).
  
  
  CONCLUSIONS
  Open operations, concurrent Nissen and younger age at placement were all statistically significant factors causing persistent GCF.
authors: Department of Pediatric Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR, USA. Electronic address: dlwyrick@uams.edu.
authors: Deidre L
authors: DL
authors: Wyrick
authors: Andrew P
authors: AP
authors: Bozeman
authors: Samuel D
authors: SD
authors: Smith
authors: Richard J
authors: RJ
authors: Jackson
authors: R Todd
authors: RT
authors: Maxson
authors: Karen R
authors: KR
authors: Kelley
authors: Donna L
authors: DL
authors: Mathews
authors: Jingyun
authors: J
authors: Li
authors: Christopher J
authors: CJ
authors: Swearingen
authors: Melvin S
authors: MS
authors: Dassinger
mesh_terms: D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005747:Gastric Fistula / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Gastrocutaneous fistula; Gastrostomy tube; Nissen fundoplication