Outpatient curettage and electrocautery as an alternative to primary surgical closure for pediatric gastrocutaneous fistulae
| Autor: | John Hagen, Steven Stylianos, Ibrahim Abd El-Shafy, Naomi-Liza Denning, Aaron M. Lipskar, Jose M. Prince |
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| Rok vydání: | 2018 |
| Předmět: |
Gastric Fistula
Male medicine.medical_specialty Adolescent Cutaneous Fistula Fistula medicine.medical_treatment Operative Time Curettage 03 medical and health sciences Postoperative Complications 0302 clinical medicine 030225 pediatrics Electrocoagulation medicine Humans Child Retrospective Studies Gastrostomy Curette business.industry Patient Selection Gold standard General Medicine medicine.disease Surgery Treatment Outcome Ambulatory Surgical Procedures Child Preschool Cauterization Female 030211 gastroenterology & hepatology Complication Airway business Recovery Room |
| Zdroj: | Journal of Surgical Research. 229:96-101 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2018.03.037 |
| Popis: | BACKGROUND The development of a gastrocutaneous fistula (GCF) after gastrostomy tube removal is a frequent complication that occurs 5%-45% of the time. Conservative therapy with chemical cauterization is frequently unsuccessful, and surgical GCF repair with open primary layered closure of the gastrotomy is often required. We describe an alternative approach of GCF closure that is an outpatient, less invasive procedure that allows patients to avoid the comorbidities of general endotracheal anesthesia and intraabdominal surgery. METHODS This is an Institutional Review Board approved retrospective review of all patients who underwent GCF closure from January 2010 to July 2016 at a tertiary care children's hospital. Demographics including age, weight, body mass index, comorbidities, and initial indication for gastrostomy tube were recorded. Operative details such as ASA score, operative duration, type of anesthesia, and airway were noted. Based on surgeon preference, two types of operative closure were used during that time frame: primary layered closure or curettage and cautery (C&C). The latter is a procedure in which the fistula tract is first scraped with a fine curette, and then the fistula opening and tract are cauterized circumferentially. Finally, the presence of a persistent fistula and the need for formal reoperation were determined. RESULTS Sixty-five unique patients requiring GCF closure were identified. Of those, 44 patients (67.6%) underwent primary closure and 21 patients (32.3%) underwent C&C. The success rate of primary closure was 97% with one patient experiencing wound breakdown with persistent fistula. The overall success rate of C&C was 66.7% (14/21). Among those 14 patients, 11 (52.4%) GCF patients were closed by 1 mo. An additional two patients' gastrocutaneous fistulae were closed by 4 mo (61.9%). One GCF was successfully closed with a second C&C procedure. Seven of the 21 patients (33.3%) required subsequent formal layered surgical closure. C&C had significantly shorter operative times (13.5 ± 14.7 min versus 93.4 ± 61.8, P |
| Databáze: | OpenAIRE |
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