Transfascial temporary fixation is associated with an increased rate of return to the operating room after gastrostomy tube dislodgement when compared to the subcutaneous stay suture technique: A single-institution retrospective analysis.

BACKGROUND

Gastrostomy tube dislodgement is a common postoperative complication in children, with reported rates of dislodgement from 10% to 43%. Understanding, and ultimately reducing, gastrostomy tube dislodgements and their consequences can help decrease the significant morbidity from this complication. We quantified the incidence, contributing factors, and complications after gastrostomy tube dislodgements at our institution.

METHODS

We conducted a single-institution retrospective review of children who underwent initial laparoscopic gastrostomy tube placement between August 2019 and August 2024. We performed descriptive statistics of demographic and surgical data, univariate analysis, and multivariable logistic regression, with the primary outcome of gastrostomy tube dislodgement. We defined statistical significance as p < 0.05.

RESULTS

Among 755 patients who underwent laparoscopic gastrostomy tube placement, 275 (36.4%) had a tube dislodgement and 21 (2.8%) required reoperation due to dislodgement. Dislodgements that occurred within 30 days postoperatively were nearly three times as likely to require operative intervention (10.0% vs. 3.5%, OR 3.10, 95% CI 1.28-7.54; p = 0.04). Dislodgement rates were similar between the transfacial temporary fixation technique (TTFT) and the subcutaneous stay suture technique (SSST) (37.1% vs 33.4%, respectively; p = 0.81). However, patients who underwent placement via the TTFT had an increased risk of return to the OR after dislodgement (6.1% vs. 0.0%, p = 0.02).

CONCLUSION

Gastrostomy tube dislodgement is a common occurrence. While the TTFT and SSST laparoscopic techniques are associated with similar gastrostomy tube dislodgement rates, TTFT is associated with an increased rate of return to the OR after dislodgement. Surgeons should consider SSST as a means to minimizing morbidity after dislodgement.