Technique and History of Abdominal Surgery Are Associated With Need for Gastrocutaneous Fistula Closure Following Gastrostomy Removal: A Case-Control Study.

INTRODUCTION

Following gastrostomy tube (GT) removal, persistent gastrocutaneous fistula (GCF) requiring operative closure is a common occurrence. We sought to examine factors associated with the need for operative closure of a GCF in pediatric patients.

MATERIALS AND

METHODS

A retrospective case-control study of patients who underwent GT placement and removal from 2018 to 2023 was performed. Direct comparisons and multivariate regression models were used to determine factors associated with the need for operative closure of a GCF.

RESULTS

During the study period, 618 patients underwent GT placement. Of those, only 178 patients subsequently underwent removal and were included. The prevalence of GCF requiring operative closure was 27.5%. Multivariate analysis demonstrated prior and concurrent abdominal surgery were associated with increased odds of GCF (odds ratio [OR] 5.30, 95% confidence interval [CI] 1.27-23.6, P = 0.023; OR 4.50, 95% CI 1.23-17.1, P = 0.024 respectively). Purse-string securement significantly increased the odds of persistent GCF when compared to transabdominal Stamm securement without purse string (OR 8.52, 95% CI 2.73-28.6, P < 0.001) without any difference in GT dislodgement (P = 0.639). Younger age was associated with GCF on comparative cohort analysis (P < 0.001). When stratifying patients as greater or less than 6 mo of age, newborn patients had higher rates of GCF closure (P = 0.025) and shorter durations between placement and removal (P = 0.008).

CONCLUSIONS

GCF is associated with younger age, other abdominal surgeries, and securement techniques. Transabdominal securement may be associated with a reduced risk of persistent GCF without associated increase in dislodgment. Given the increased rate of persistent GCF and shorter duration of GT needs in younger patients, discharge with a nasoenteric tube rather than a GT should be considered for children under 6 mo.