title: A comparison of pediatric gastrostomy tube placement techniques.
abstract: OBJECTIVE
  This study aimed to compare different techniques for placement of gastrostomy tubes in a pediatric population.
  
  
  METHODS
  A retrospective review was performed for patients less than 18 years of age who underwent gastrostomy tube placement at a single academic children's hospital between 2010 and 2012. Techniques for gastrostomy placement included Open Stamm, percutaneous endoscopic gastrostomy (PEG), fluoroscopy guided, laparoscopic, and laparoscopic assisted PEG. Pre-operative characteristics of patients and post-operative outcomes were compared between techniques.
  
  
  RESULTS
  Most patients underwent an Open Stamm (43 %) or PEG (39 %). There were significant differences between groups with respect to primary diagnoses, prior surgeries, and ASA classification. Major complications were rare, with less than 3 % requiring reoperation within 30 days; however, minor complications and returns to the emergency department were common. Unintentional tube dislodgements occurred in 22 % of all patients, with Open Stamm technique identified as an independent predictor of unintentional dislodgement (p < 0.0001).
  
  
  CONCLUSIONS
  Although conclusions from this retrospective analysis are limited due to heterogeneity between groups, open Stamm gastrostomy placement in children was associated with increased negative outcomes including unintentional tube dislodgements, returns to the emergency department, and need for reoperation within 30 days. Prospective analysis of the various techniques is needed to confirm that minimally invasive techniques for gastrostomy tube placement are associated with a less complicated post-operative course.
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA.|Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sulkowski
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA.
authors.forename: Ana C
authors.initials: AC
authors.lastname: De Roo
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA.|Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Nielsen
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Ambeba
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Cooper
authors.affiliation: Department of Radiology, Nationwide Children's Hospital, Columbus, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hogan
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Erdman
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA.|Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA.|Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Center for Surgical Outcomes Research, Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, 700 Children's Drive, Suite ED324, Columbus, OH, 43205-2696, USA. brian.kenney@nationwidechildrens.org.|Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, USA. brian.kenney@nationwidechildrens.org.
authors.forename: Brian
authors.identifier: http://orcid.org/0000-0001-7491-1999
authors.initials: B
authors.lastname: Kenney
mesh_terms: D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies
keywords: Dislodgement; Gastrostomy; Outcomes; Percutaneous endoscopic gastrostomy