The Effect of Surgical Approach on Postoperative Complications Following Pediatric Gastrostomy Tube Placement

Purpose: Gastropexy during laparoscopic gastrostomy tube (GT) placement is commonly achieved using transfascial sutures (TFS), transabdominal sutures (TAS), or T-fasteners (TF). It is unknown whether the method of gastropexy influences the incidence of postoperative complications. We aimed to determine if the gastropexy approach impacts rates of common complications after laparoscopic GT placement. Methods: A single-center retrospective review of children who underwent laparoscopic GT placement from January 2018 to May 2023 was conducted. Patients with concomitant procedures labeled wound class II (clean-contaminated) or greater were excluded. Primary outcomes included cellulitis, tube dislodgement, granulation tissue, emergency department visits, readmission, and reoperation. Comparisons were made between gastropexy approaches. Results: A total of 332 patients were analyzed. One hundred seventy-nine children had TFS, 110 had TAS, and 43 had TF. Children with TF were older than other cohorts and more likely to have a GT placed for medication/fluid access. Patients with TAS placed less phone calls to the pediatric surgery clinic postoperatively compared to those with TFS or TF. All other complications were comparable between cohorts. Conclusions: The gastropexy approach does not significantly impact rates of postoperative complications following laparoscopic GT placement in pediatric patients. The gastropexy approach may impact the number of postoperative phone calls, but the reasoning for this is unclear.