Extraperitoneal closure of persistent gastrocutaneous fistula in children

Abstract

Background and Objectives: Gastrostomy feeding in children is well established for nutritional support. Gas- trostomy tubes may be permanent or temporary. After removal, spontaneous closure may occur, but persistence of the tract requires surgical repair. Laparotomy with gas- tric repair and fascial closure is the standard technique for treatment of a persistent gastrocutaneous fistula. We de- scribe a technique of extraperitoneal excision of the fis- tulous tract and our results using this method. Methods: We reviewed 21 cases of extraperitoneal gas- trocutaneous fistula closure in which a Foley catheter traction technique was used and were performed over the last 8 y. The technique involves insertion of a small Foley catheter with traction applied to the fistulous tract and core excision with electrocautery. Closure of the tract without fascial separation was accomplished and early feedings were allowed. Results: Ten males and 11 females underwent closure with this technique. The duration of the gastrostomy ranged from 1 y to 6 y, with a mean of 3.3 y. The time from removal to surgical repair was 3 wk to 1 y, with a mean of 4.3 mo; 15 had gastrostomy alone, and 6 had gastrostomy in combination with Nissen fundoplication. Open gastros- tomy had been done in 10 patients and laparoscopic gastrostomy in 11 patients. Half of the patients had an ambulatory procedure. One patient developed a superfi- cial wound infection, and there was 1 recurrence requir- ing intraperitoneal closure. Conclusion: Extraperitoneal closure for gastrocutaneous fistula is safe and effective. The technique allows for rapid resumption of feeds and a shortened length of stay. Minimal morbidity occurs with this technique, and it is well tolerated in the pediatric population. © 2013 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by the Society of Laparoendoscopic Surgeons, Inc.