title: Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study.
abstract: BACKGROUND
  A gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. However, data on efficacy, perioperative complications and postoperative gastroesophageal reflux (GER) after laparoscopic gastrostomy (LAG) placement is limited. The aim of this study is to evaluate long-term efficacy and adverse events after LAG in a large cohort and determine whether routine preoperative 24-h pH monitoring should be used to predict postoperative GER.
  
  
  METHODS
  A retrospective observational cohort study was performed including 300 patients (75 % neurologically impaired) that underwent LAG.
  
  
  RESULTS
  After a median follow-up of 2.63 years, feeding was successful in 95.9 % of patients. Weight-for-length z-scores significantly increased (p < 0.0005). Major complications were seen in only 6 patients (2.0 %), but minor complications occurred frequently (73.6 %). Overall incidence of GER remained unchanged after LAG. Sensitivity and specificity of preoperative pH monitoring were 17.5 and 76.9 %, respectively.
  
  
  CONCLUSIONS
  LAG placement in pediatric patients leads to successful feeding in 96 % of patients and serious adverse events are rare. However, the minor complication rate is high. Overall incidence of GER does not increase after LAG. Preoperative 24-h pH monitoring is not a reliable tool to predict postoperative GER. This invasive investigation technique should therefore not be routinely performed.
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
authors.forename: Josephine
authors.initials: J
authors.lastname: Franken
authors.forename: Femke A
authors.initials: FA
authors.lastname: Mauritz
authors.forename: Nutnicha
authors.initials: N
authors.lastname: Suksamanapun
authors.forename: Caroline C C
authors.initials: CC
authors.lastname: Hulsker
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.forename: Maud Y A
authors.initials: MY
authors.lastname: van Herwaarden-Lindeboom
mesh_terms: D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies