Skip to main content
SpringerLink
Log in

Elective laparoscopic gastrostomy in children: potential for an enhanced recovery protocol

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

Gastrostomy tube placement is one of the most commonly performed pediatric surgical procedures and discharge is possible as early as the first postoperative day with early initiation of feeds postoperatively. We examined a national database to determine hospital length of stay (LOS) after elective laparoscopic gastrostomy in children.

Methods

We queried the 2012–2013 National Surgical Quality Improvement Program Pediatric (NSQIP-P) database, including all patients who underwent elective laparoscopic gastrostomy tube placement for failure to thrive or feeding difficulties. Demographic data, admission status, disposition at discharge, surgical subspecialty data and hospital LOS were extracted.

Results

A total of 599 patients underwent gastrostomy tube placement for failure to thrive or feeding intolerance. The majority, 52%, was male and 69.3% were White. The median age was 2.2 years (IQR 0.9–6.3). Of the total, 28.7% were infants. The median total hospital LOS was 2 days (IQR 1–2), with only 39% discharged in a day or less.

Conclusion

Pediatric patients undergoing elective laparoscopic gastrostomy have a median hospital length of stay of 2 days, despite evidence that early feeding and discharge within 24 h is both feasible and safe. There is potential for the implementation of an enhanced recovery protocol as a quality metric for this procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149(6):830–840

    Article  PubMed  Google Scholar 

  2. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101(3):172–188

    Article  CAS  PubMed  Google Scholar 

  3. Shinnick JK, Short HL, Heiss KF, Santore MT, Blakely ML, Raval MV (2016) Enhancing recovery in pediatric surgery: a review of the literature. J Surg Res 202(1):165–176

    Article  PubMed  Google Scholar 

  4. Behr CA, Hesketh AJ, Akerman M, Dolgin SE, Cowles RA (2015) Recent trends in the operative experience of junior pediatric surgical attendings: a study of APSA applicant case logs. J Pediatr Surg 50(1):186–190

    Article  PubMed  Google Scholar 

  5. Sunstrom R, Hamilton N, Fialkowski E et al (2016) Minimizing variance in pediatric gastrostomy: does standardized perioperative feeding plan decrease cost and improve outcomes? Am J Surg 211(5):948–953

    Article  PubMed  Google Scholar 

  6. Pearsall EA, Meghji Z, Pitzul KB et al (2015) A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg 261(1):92–96

    Article  PubMed  Google Scholar 

  7. Murthy K, Dykes FD, Padula MA et al (2014) The Children’s Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in care. J Perinatol 34(8):582–586

    Article  CAS  PubMed  Google Scholar 

  8. Werlin S (1994) Early feeding after percutaneous endoscopic gastrostomy is safe in children. Gastointest Endosc 40(6):692–693

    Article  CAS  Google Scholar 

  9. Franken J, Mauritz FA, Suksamanapun N, Hulsker CC, van der Zee DC, van Herwaarden-Lindeboom MY (2015) Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study. Surg Endosc 29(6):1545–1552

    Article  PubMed  Google Scholar 

  10. Islek A, Sayar E, Yilmaz A, Artan R (2013) Percutaneous endoscopic gastrostomy in children: is early feeding safe? J Pediatr Gastroenterol Nutr 57(5):659–662

    Article  PubMed  Google Scholar 

  11. Sabir SH, Armstrong R, Elting LS, Wallace MJ, Gupta S, Tam AL (2014) Early initiation of enteral feeding in cancer patients after outpatient percutaneous fluoroscopy-guided gastrostomy catheter placement. J Vasc Intervent Radiol (JVIR) 25(4):618–622

    Article  Google Scholar 

  12. Surgeons ACo. https://www.facs.org/quality-programs/childrens-surgery/pediatric/program-specifics/quality-support-tools/puf. Accessed 15 Dec 2018

  13. Wragg RC, Salminen H, Pachl M et al (2012) Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series. Pediatr Surg Int 28(5):443–448

    Article  PubMed  Google Scholar 

  14. Angsten G, Danielson J, Kassa AM, Lilja HE (2015) Outcome of laparoscopic versus open gastrostomy in children. Pediatr Surg Int 31(11):1067–1072

    Article  PubMed  Google Scholar 

  15. Vasseur Maurer S, Reinberg O (2015) Laparoscopic technique to perform a true Stamm gastrostomy in children. J Pediatr Surg 50(10):1797–1800

    Article  PubMed  Google Scholar 

  16. Jones VS, La Hei ER, Shun A (2007) Laparoscopic gastrostomy: the preferred method of gastrostomy in children. Pediatr Surg Int 23(11):1085–1089

    Article  CAS  PubMed  Google Scholar 

  17. Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248(2):189–198

    Article  PubMed  Google Scholar 

  18. Lassen K, Soop M, Nygren J et al (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144(10):961–969

    Article  PubMed  Google Scholar 

  19. Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56(5):667–678

    Article  PubMed  Google Scholar 

  20. Fox D, Campagna EJ, Friedlander J, Partrick DA, Rees DI, Kempe A (2014) National trends and outcomes of pediatric gastrostomy tube placement. J Pediatr Gastroenterol Nutr 59(5):582–588

    Article  PubMed  Google Scholar 

  21. Thatch KA, Yoo EY, Arthur LG 3rd (2010) A comparison of laparoscopic and open Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit population. J Pediatr Surg 45(2):346–349

    Article  PubMed  Google Scholar 

  22. Hendrickson RJ, Poola AS, Sujka JA et al (2018) Feeding advancement and simultaneous transition to discharge (FASTDischarge) after laparoscopic gastrostomy. J Pediatr Surg 53(11):2326–2330

    Article  PubMed  Google Scholar 

  23. Best C, Hitchings H (2010) Day case gastrostomy placement for patients in the community. Br J Commun Nurs 15(6):272–278

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA

    Kibileri Williams

  2. Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA

    Lauren Baumann

  3. Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611, USA

    Fizan Abdullah

  4. Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA

    Richard J. Hendrickson & Tolulope A. Oyetunji

Authors
  1. Kibileri Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren Baumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fizan Abdullah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard J. Hendrickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tolulope A. Oyetunji
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KW assisted with data analysis and was the primary author of the manuscript. LB assisted with writing of the manuscript. FA and RJH provided final editing of the manuscript. TAO conceptualized the project, performed data analysis and supervised the preparation of the manuscript.

Corresponding author

Correspondence to Tolulope A. Oyetunji.

Ethics declarations

Conflict of interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Williams, K., Baumann, L., Abdullah, F. et al. Elective laparoscopic gastrostomy in children: potential for an enhanced recovery protocol. Pediatr Surg Int 35, 643–647 (2019). https://doi.org/10.1007/s00383-019-04472-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-019-04472-7

Keywords

Search

Navigation