title: Safety of percutaneous endoscopic gastrostomy after trauma laparotomy.
abstract: BACKGROUND
  Trauma patients frequently require long-term enteral access because of injuries to the head, neck, or gastrointestinal tract. Noninvasive methods for gastrostomy placement include percutaneous endoscopic gastrostomy (PEG) and percutaneous radiographic gastrostomy (PRG). In patients with recent trauma laparotomy, PEG placement is felt to be relatively contraindicated because of the concerns about altered anatomy. We hypothesize that there is no increased rate of complications related to PEG placement in patients with trauma laparotomy compared with those without laparotomy provided that basic safety principles are followed.
  
  
  METHODS
  This retrospective study evaluates all percutaneous gastrostomies (both PEG and PRG) placed in trauma patients admitted at a level I trauma center between January 1, 2007 and March 30, 2010. The electronic medical records of the 354 patients were reviewed through 30 days after procedure, and patients were further subdivided by the history of laparotomy. Statistical analysis was performed using Fisher exact test or two-tailed t-test, as appropriate.
  
  
  RESULTS
  In patients with no prior trauma laparotomy, successful PEG placement occurred in 92.2% of patients, the remainder underwent PRG placement. Of patients with prior trauma laparotomy, 82.4% had successful PEG placement. Two percent of attempted PEG placements failed in patients with no previous trauma laparotomy, whereas 11.8% failed in patients with recent trauma laparotomy. The overall complication rate was 2.0%, with no recorded complications in patients with trauma laparotomy before PEG placement.
  
  
  CONCLUSIONS
  These data suggest that surgeons should not consider recent trauma laparotomy a contraindication to PEG placement.
authors: Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota.
authors: Elizabeth A
authors: EA
authors: Wyman
authors: Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota.
authors: Rachel M
authors: RM
authors: Nygaard
authors: Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota.
authors: Chad J
authors: CJ
authors: Richardson
authors: Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota. Electronic address: Robert.Quickel@hcmed.org.
authors: Robert R
authors: RR
authors: Quickel
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000601:surgery*
keywords: Critical care; Laparotomy; Patient management; Percutaneous endoscopic gastrostomy; Trauma