Outcomes of laparoscopic gastrostomy in children with and without the use of a modified T-fastener technique

Background: Laparoscopic gastrostomy is commonly performed for durable enteral access in children. T-fasteners have been used intraoperatively to achieve a secure gastropexy, traditionally using external bolsters. We compare the safety profile of a modified paired T-fastener technique to standard laparoscopic-assisted suture gastropexy.Methods: A retrospective matched case-control study was performed of pediatric patients who underwent laparoscopic gastrostomy at a single center from 2015 to 2021. In the paired T-fastener group, pairs of T-fasteners were passed into the stomach in a square configuration, allowing the suture pairs to be tied subcutaneously. This cohort was matched in a 1:2 fashion with age, sex, and body mass index or weightmatched controls who underwent laparoscopic gastrostomy with buried transabdominal gastropexy.Results: Thirty patients underwent laparoscopic gastrostomy using the paired T-fastener technique and were matched to 60 controls. There was no significant difference in median operative time or 30-day complication rates between the groups, but the paired T-fastener technique significantly reduced the number of trocars required, and it was used for patients with thicker abdominal walls. Conclusion: We demonstrate the modified paired T-fastener technique as a safe, efficient means of gastropexy in pediatric laparoscopic gastrostomy. The paired T-fastener approach eliminates external bolsters, reduces additional trocars, and may be advantageous for thicker abdominal walls while maintaining a similar complication profile to standard laparoscopic gastrostomy.& COPY; 2023 Elsevier Inc. All rights reserved.

Automated summary

This study compared the safety and effectiveness of a modified paired T-fastener technique with standard laparoscopic-assisted suture gastropexy in pediatric gastrostomy. The results showed that the modified paired T-fastener technique is a safe and efficient method for pediatric gastrostomy, and it significantly reduces the number of additional trocars compared to the traditional method, which is advantageous for patients with thicker abdominal walls.