Persistence of Gastrocutaneous Fistula after Removal of Gastrostomy Tubes in Children: Prevalence and Associated Factors

Background and Study Aims: The aims of this study were to determine the prevalence of gastrocutaneous fistula after removal of gastrostomy tubes in children and to identify associated risk factors.
Patients and Methods: The records of children who had undergone removal of gastrostomy tubes between January 1992 and December 2002 were reviewed retrospectively. Persistent gastrocutaneous fistula was defined as the absence of closure of the gastrostomy 1 month after tube removal. Factors that might influence spontaneous closure of the gastrostomy were studied, including age, underlying disease, nutritional status, type of gastrostomy, replacement of the gastrostomy tube by a button, abdominal wall thickness, duration of gastrostomy tube or button placement, and complications related to the presence of the gastrostomy (infection, granulation tissue).
Results: A total of 44 patients were included in the study (mean age 20 months, range 1 day to 14 years). Of these, 28 had undergone percutaneous endoscopic gastrostomy and 16 surgical gastrostomy. The mean time to spontaneous closure was 6 ± 7 days. Persistent gastrocutaneous fistula developed in 11 patients (25 %) and in seven of these patients this required surgical closure (16 %). The mean duration of gastrostomy placement was significantly longer in patients who went on to develop a gastrocutaneous fistula than in patients who did not develop a fistula (39 ± 19 months vs. 22 ± 23 months, respectively, P < 0.03). No other significant association was found between the time required for spontaneous closure and the characteristics of patients or the type of gastrostomy.
Conclusions: Persistent gastrocutaneous fistula is common after removal of gastrostomy tubes in children. Surgical closure should be considered when a gastrostomy has not closed spontaneously 1 month after removal of the gastrostomy tube.

References

• 1 Corwin D S, Isaacs J S, Georgeson K E. et al . Weight and length increases in children after gastrostomy placement.  J Am Diet Assoc. 1996;  96 874-879
• 2 Kutiyanawala M A, Hussain A, Johnstone J MS. et al . Gastrostomy complications in infants and children.  Ann R Coll Surg Engl. 1998;  80 240-243
• 3 Gauderer M W. Percutaneous endoscopic gastrostomy: 10-year experience with 220 children.  J Pediatr Surg. 1991;  26 288-294
• 4 Kealy W D, McCallon W A, Boston V E. Tension pneumoperitoneum: a potentially life-threatening complication of percutaneous endoscopic gastrostomy.  J Pediatr Gastroenterol Nutr. 1996;  22 334-335
• 5 Davidson P M, Catto-Smith A G, Beasley S W. Technique and complications of percutaneous endoscopic gastrostomies in children.  Aust N Z J Surg. 1995;  65 194-196
• 6 Jarnagin W R, Duh Q Y, Mulvihill S J. et al . The efficacy and limitation of percutaneous endoscopic gastrostomy.  Surgery. 1992;  127 261-264
• 7 Segal D, Michaud L, Guimber D. et al . Late-onset complications of percutaneous endoscopic gastrostomy in children.  J Pediatr Gastroenterol Nutr. 2001;  33 495-500
• 8 Khattak I U, Kimber C, Kiely E M, Spitz L. Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome.  J Pediatr Surg. 1998;  33 67-72
• 9 Shellito P C, Malt R A. Tube gastrostomy: techniques and complications.  Ann Surg. 1985;  201 180-185
• 10 Chowdhury M A, Batey R. Complications and outcome of percutaneous endoscopic gastrostomy in different patient groups.  J Gastroenterol Hepatol. 1996;  11 835-839
• 11 Gordon J M, Langer J C. Gastrocutaneous fistula in children after removal of gastrostomy tube: incidence and predictive factors.  J Pediatr Surg. 1999;  34 1345-1346
• 12 Kobak G E, McClenathan D T, Schurman S J. Complications of removing percutaneous endoscopic gastrostomy tubes in children.  J Pediatr Gastroenterol Nutr. 2000;  30 404-407
• 13 Davies B W, Watson A R, Coleman J E, Rance C H. Do gastrostomies close spontaneously? A review of the fate of gastrostomies following successful renal transplantation in children.  Pediatr Surg Int. 2001;  17 326-328
• 14 Aronian J M, Redo S F. Gastrocutaneous fistula after tube gastrostomy: incidence in infants and children.  N Y State J Med. 1974;  74 2364-2366
• 15 Haws E B, Sieber W K, Kiesewetter W B. Complications of tube gastrostomy in infants and children: 15-year review of 240 cases.  Ann Surg. 1966;  164 284-290
• 16 Shellito P C, Malt R A. Tube gastrostomy: techniques and complications.  Ann Surg. 1985;  201 180-185
• 17 Mahajan L, Oliva L, Wyllie R. et al . The safety of gastrostomy in patients with Crohn’s disease.  Am J Gastroenterol. 1997;  92 985-988
• 18 Bender J S, Levison M A. Complications after percutaneous endoscopic gastrostomy removal.  Surg Laparosc Endosc. 1991;  1 101-103
• 19 Holder T M, Leape L L, Ashcraft K. Gastrostomy: its use and dangers in pediatric patients.  N Engl J Med. 1972;  286 1345-1347