Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants

Abstract

Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved.

Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures.

Results The 141 included infants underwent surgery at a median age of 10 months (range: 1–24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4–30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes, but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis.

Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.

Keywords

laparoscopic-assisted gastrostomy - infants - wound infections - complications - bacterial culture - antibiotics

Author Disclosure Statement

No disclosures

^* Two first authors.

• References

• 1 Löser C, Aschl G, Hébuterne X. , et al. ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24 (05) 848-861
• 2 Backman T, Arnbjörnsson E, Berglund Y, Larsson LT. Video-assisted gastrostomy in infants less than 1 year. Pediatr Surg Int 2006; 22 (03) 243-246
• 3 Andersson L, Mikaelsson C, Arnbjörnsson E, Larsson LT. Laparoscopy aided gastrostomy in children. Ann Chir Gynaecol 1997; 86 (01) 19-22
• 4 Backman T, Sjövie H, Kullendorff CM, Arnbjörnsson E. Continuous double U-stitch gastrostomy in children. Eur J Pediatr Surg 2010; 20 (01) 14-17
• 5 Akay B, Capizzani TR, Lee AM. , et al. Gastrostomy tube placement in infants and children: is there a preferred technique?. J Pediatr Surg 2010; 45 (06) 1147-1152
• 6 Landisch RM, Colwell RC, Densmore JC. Infant gastrostomy outcomes: the cost of complications. J Pediatr Surg 2016; 51 (12) 1976-1982
• 7 Liu R, Jiwane A, Varjavandi A. , et al. Comparison of percutaneous endoscopic, laparoscopic and open gastrostomy insertion in children. Pediatr Surg Int 2013; 29 (06) 613-621
• 8 Merli L, De Marco EA, Fedele C. , et al. Gastrostomy placement in children: percutaneous endoscopic gastrostomy or laparoscopic gastrostomy?. Surg Laparosc Endosc Percutan Tech 2016; 26 (05) 381-384
• 9 Petrosyan M, Khalafallah AM, Franklin AL, Doan T, Kane TD. Laparoscopic gastrostomy is superior to percutaneous endoscopic gastrostomy tube placement in children less than 5 years of age. J Laparoendosc Adv Surg Tech A 2016; 26 (07) 570-573
• 10 Sulkowski JP, De Roo AC, Nielsen J. , et al. A comparison of pediatric gastrostomy tube placement techniques. Pediatr Surg Int 2016; 32 (03) 269-275
• 11 Wragg RC, Salminen H, Pachl M. , et al. Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series. Pediatr Surg Int 2012; 28 (05) 443-448
• 12 Zamakhshary M, Jamal M, Blair GK, Murphy JJ, Webber EM, Skarsgard ED. Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard?. J Pediatr Surg 2005; 40 (05) 859-862
• 13 Backman T, Berglund Y, Sjövie H, Arnbjörnsson E. Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt. Pediatr Surg Int 2007; 23 (07) 665-668
• 14 Arnbjörnsson E, Backman T, Mörse H, Berglund Y, Kullendorff CM, Lövkvist H. Complications of video-assisted gastrostomy in children with malignancies or neurological diseases. Acta Paediatr 2006; 95 (04) 467-470
• 15 Backman T, Sjövie H, Mellberg M. , et al. Pre- and postoperative vomiting in children undergoing video-assisted gastrostomy tube placement. Surg Res Pract 2014; 2014: 871325
• 16 Salö M, Santimano A, Helmroth S, Stenström P, Arnbjornsson EÓ. Long-term outcomes of children undergoing video-assisted gastrostomy. Pediatr Surg Int 2017; 33 (01) 85-90
• 17 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
• 18 van Els AL, van Driel JJ, Kneepkens CF, de Meij TG. Antibiotic prophylaxis does not reduce the infection rate following percutaneous endoscopic gastrostomy in infants and children. Acta Paediatr 2017; 106 (05) 801-805
• 19 Fascetti-Leon F, Gamba P, Dall'Oglio L. , et al. Complications of percutaneous endoscopic gastrostomy in children: results of an Italian multicenter observational study. Dig Liver Dis 2012; 44 (08) 655-659
• 20 Fujiogi M, Tanaka Y, Amano H. , et al. A new laparoscopic triangle fixation technique for gastrostomy: a safe and effective procedure for reduction of the wound infection rate. Nagoya J Med Sci 2018; 80 (04) 497-503
• 21 Miyagi H, Honda S, Minato M, Okada T, Taketomi A. Factors associated with the risk of persistent gastrostomy site infection following laparoscopic or open Nissen fundoplication. Afr J Paediatr Surg 2017; 14 (02) 21-23
• 22 Mason CA, Skarda DE, Bucher BT. Outcomes after laparoscopic gastrostomy suture techniques in children. J Surg Res 2018; 232: 26-32
• 23 McCagg J, Markham S, Idowu O, Newton C, Palmer B, Kim S. Modification of U-stitch laparoscopic gastrostomy technique to minimize suture knot abscess formation. Eur J Pediatr Surg 2016; 26 (03) 252-254
• 24 Aprahamian CJ, Morgan TL, Harmon CM, Georgeson KE, Barnhart DC. U-stitch laparoscopic gastrostomy technique has a low rate of complications and allows primary button placement: experience with 461 pediatric procedures. J Laparoendosc Adv Surg Tech A 2006; 16 (06) 643-649
• 25 Poola AS, Weaver KL, Sola R. , et al. Transabdominal versus subcuticular sutures to secure a laparoscopic gastrostomy. J Laparoendosc Adv Surg Tech A 2018; 28 (07) 884-887
• 26 Stamm M. Gastrostomy: a new method. Med Newsl (Lond) 1894; 65: 32
• 27 Kaya M, Sancar S, Ozcakir E. A new method for laparoscopic Stamm gastrostomy. J Laparoendosc Adv Surg Tech A 2018; 28 (01) 111-115
• 28 Vasseur Maurer S, Reinberg O. Laparoscopic technique to perform a true Stamm gastrostomy in children. J Pediatr Surg 2015; 50 (10) 1797-1800
• 29 Baker L, Beres AL, Baird R. A systematic review and meta-analysis of gastrostomy insertion techniques in children. J Pediatr Surg 2015; 50 (05) 718-725
• 30 Lukish J, Pryor H, Rhee D. , et al. A novel continuous stitch fundoplication utilizing knotless barbed suture in children with gastroesophageal reflux disease: a pilot study. J Pediatr Surg 2015; 50 (02) 272-274
• 31 Patel K, Wells J, Jones R, Browne F, Moss C, Parikh D. Use of a novel laparoscopic gastrostomy technique in children with severe epidermolysis bullosa. J Pediatr Gastroenterol Nutr 2014; 58 (05) 621-623
• 32 Baker L, Emil S, Baird R. A comparison of techniques for laparoscopic gastrostomy placement in children. J Surg Res 2013; 184 (01) 392-396