Pediatric Laparoscopic Surgery – Gastronomy Replacement
Gastronomy tube placement is a procedure done through pediatric laparoscopic surgery to place a feeding tube into the stomach. This tube is used to provide nutrition, as well as medication, for patients who are having a difficult time thriving and cannot feed themselves or take food in orally. In many cases, the gastronomy tube is placed due to neurologic disease.
G-tubes sometimes become dislodged, and patients are placed into an emergency department or other acute care setting to have the tube replaced.
Indications for Replacement of the G-Tube
Because the tube tract for a G-tube can close within just hours of removal, it’s important to have the tube replaced as quickly as possible, but only if the gastronomy tube has been in place long enough to form a tract. A simple gastronomy tube typically takes one to two weeks to form a tract. If the tube becomes dislodged before this period, the staff treating the child will likely contact the provider who placed the tube, as pediatric laparoscopic surgery or fluoroscopic replacement may be required.
Hospital and care staff typically won’t try to replace a new tube that has not formed a proper tract, as this can lead to misplacement of the tube into the peritoneal cavity. If the site appears to be inflamed or shows sign of infection, staff will wait to perform the replacement until treatment of the infection is completed. Catheter-related infections such as those seen around G-tubes frequently respond to localized wound care and oral antibiotics.
Unfortunately, in treatment with the antibiotics, tracts can often close, requiring G-tube replacement using operative procedures such as pediatric laparoscopic surgery.
Pediatric Laparoscopic Surgery – Common Complications
In many cases, the G-tube is only partially dislodged. In order to replace a gastronomy tube, the original tube must be completely removed. Depending on the type of tube, it may not be able to be removed safely in the emergency department or care facility. Some gastronomy tubes modified with rings or bolsters when inserted will require minimally invasive endoscopy or pediatric laparoscopic surgery for complete, safe removal.
The most unfortunate but rare complication from gastronomy tube replacement is misplacement of the tube into the peritoneal cavity. This cavity is the space between the two membranes (parietal peritoneum and visceral peritoneum) which separate the organs in the abdominal cavity from the abdominal wall. If feedings are started in a misplaced tube, the introduction of foreign matter into the peritoneum often leads to serious morbidity and potential mortality.
Bleeding is another complication. While a small amount of blood during pediatric laparoscopic surgery is expected, large amounts of blood will prompt a specialist consultation.
In some cases where a tract has narrowed, forced insertion and replacement of the G-tube can cause the stomach to separate from the external stoma, leading to leaking of stomach contents and peritonitis. As such, with all of the above in mind, providers typically rely on careful manual replacement or replacement using minimally invasive pediatric surgery.
North Shore-LIJ Health System employs more than 43,000 individual workers, with more than 9,000 physicians and over 10,000 nurses throughout the hospital system. In 2010, North Shore-LIJ provided more than 100,000 ambulatory “same-day” surgeries, thanks to advances in surgical technology including pediatric laparoscopic surgery.
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