title: Modification of U-Stitch Laparoscopic Gastrostomy Technique to Minimize Suture Knot Abscess Formation.
abstract: Aim U-stitch laparoscopic gastrostomy is a commonly used technique for placement of balloon gastrostomy for pediatric patients. The U-stitch method was modified by others whereby the stay sutures are placed in a subcutaneous tissue. Although this modification has been reported to be superior, it has led to suture knot abscess formation which was not reported in the original method. We developed further modification whereby the stay-suture knots are positioned within the gastrostomy tract instead of the subcutaneous tissue which minimizes suture knot abscess formation. Methods Modified U-stitch technique was used to place the balloon gastrostomy. The U-stitch stay sutures are placed to hold the stomach to the abdominal wall. These sutures are subcutaneously tunneled toward the gastrostomy tract and tied to the opposing sutures with the resulting knots lying within the tract of the gastrostomy. Chart reviews of patients who underwent this modified U-stitch method were done. Results A total of 27 consecutive patients were evaluated. Minimal follow-up period was 6 months. No suture knot abscess complication was found. One patient for whom we used a polyglactin (Vicryl; Ethicon Inc., Cincinnati, Ohio, United States) suture developed cellulitis around the gastrostomy site which cleared with antibiotic. Remaining 10 patients for whom we used Vicryl suture and 16 patients for whom polydioxanone (PDS; Ethicon Inc.) suture was used did not develop any infections. Conclusion Subcutaneous placement of stay suture within the open gastrostomy tract rather than within closed subcutaneous tissue may minimize suture knot abscess formation.
authors.affiliation: Department of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California, United States.
authors.forename: Jillian
authors.initials: J
authors.lastname: McCagg
authors.affiliation: Department of Surgery, University of California San Francisco-East Bay, Oakland, California, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Markham
authors.affiliation: Department of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California, United States.
authors.forename: Olajire
authors.initials: O
authors.lastname: Idowu
authors.affiliation: Department of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Newton
authors.affiliation: Department of Surgery, University of California San Francisco-East Bay, Oakland, California, United States.
authors.forename: Barnard
authors.initials: B
authors.lastname: Palmer
authors.affiliation: Department of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California, United States.
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Kim
mesh_terms: D000038:Abscess / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D016687:Polydioxanone / Q000627:therapeutic use; D011098:Polyglactin 910 / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures / Q000009:adverse effects*
chemical_list: D016687:Polydioxanone; D011098:Polyglactin 910