weekly_question 3/12/2023

[Admin]

A three-year old boy had a laparoscopic fundoplication and gastrostomy at 20 months of age. The gastrostomy has not been used for the past three months and he has had adequate weight gain and growth. The family would like it removed. The factor most associated with persistent gastrocutaneous fistula after removal of the button is

A size of the gastrostomy button.

B interval since initial placement.

C age of the patient.

D history of fundoplication.

E presence of a neurodevelopmental deficit.

[Admin]

Correct answer
B interval since initial placement.

The single most important determinant of spontaneous closure is the length of time elapsed since initial placement of the gastrostomy. In one study, over 90% spontaneously closed if the interval was eight months or less; 90% failed to close with a longer interval. Other reports have confirmed the importance of gastrostomy duration in spontaneous closure.

Gastrostomy is a common procedure in pediatric surgery. There are a variety of techniques for placement and many types of devices. Although most of these will remain in place long term, in approximately 15 to 40% the child returns for removal. The surgeon can simply remove the button or tube and await spontaneous closure of the fistula or surgically close the site (usually with excision of the tract and layered closure). There are sporadic reports of other closure methods such as fibrin glue injection and laparoscopic stapling.

Several studies have addressed the incidence of persistent gastrocutaneous fistula (GCF) after elective gastrostomy removal. Identification of factors influencing spontaneous resolution of the fistula would help guide management. Extant studies involve only retrospective analysis of a limited number of children. Nevertheless, type of tube or button, other medical conditions, nutritional status, exposure to steroids and initial placement method have not been shown to correlate with persistent GCF.

Children are sometimes referred for persistent GCF after a failed attempt at spontaneous closure. Less often, a tract that has appeared to be closed for months or years develops a recurrent GCF. Operative closure is best scheduled if the skin surrounding a persistent GCF is not inflamed. If there is significant skin breakdown from gastric acid or cellulitis, replacement of the gastrostomy button or a small foley catheter may control the drainage and allow the skin to heal prior to elective closure. There are times when the hole is too small to accommodate a new tube and a small subcutaneous rubber drain can be left in place after wound closure to allow drainage and adequate healing.

[Ismailmohamed]

B

[Bashar Qassas]

B..................

[Batool]

Prolonged GT duration ( B )

[Amal Adam]

B

[wphiri]

B

[wphiri]

Interval since placement

[Bilal]

B

[M Abdelbary]

B

[Admin]

Correct answer
B interval since initial placement.

The single most important determinant of spontaneous closure is the length of time elapsed since initial placement of the gastrostomy. In one study, over 90% spontaneously closed if the interval was eight months or less; 90% failed to close with a longer interval. Other reports have confirmed the importance of gastrostomy duration in spontaneous closure.

Gastrostomy is a common procedure in pediatric surgery. There are a variety of techniques for placement and many types of devices. Although most of these will remain in place long term, in approximately 15 to 40% the child returns for removal. The surgeon can simply remove the button or tube and await spontaneous closure of the fistula or surgically close the site (usually with excision of the tract and layered closure). There are sporadic reports of other closure methods such as fibrin glue injection and laparoscopic stapling.

Several studies have addressed the incidence of persistent gastrocutaneous fistula (GCF) after elective gastrostomy removal. Identification of factors influencing spontaneous resolution of the fistula would help guide management. Extant studies involve only retrospective analysis of a limited number of children. Nevertheless, type of tube or button, other medical conditions, nutritional status, exposure to steroids and initial placement method have not been shown to correlate with persistent GCF.

Children are sometimes referred for persistent GCF after a failed attempt at spontaneous closure. Less often, a tract that has appeared to be closed for months or years develops a recurrent GCF. Operative closure is best scheduled if the skin surrounding a persistent GCF is not inflamed. If there is significant skin breakdown from gastric acid or cellulitis, replacement of the gastrostomy button or a small foley catheter may control the drainage and allow the skin to heal prior to elective closure. There are times when the hole is too small to accommodate a new tube and a small subcutaneous rubber drain can be left in place after wound closure to allow drainage and adequate healing.