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Predictive Factors for Persistent Gastrocutaneous Fistula after Removal of Gastrostomy Device in Children - Abstract

Hussein Naji, Said Zeiai

 

Abstract

Aim

 Many children with gastrostomy return to normal per-oral diet and require removal of the gastrostomy device which may result in a persistent gastrocutaneous fistula. The purpose of this study was to determine the predictive factors for persistent gastrocutaneous fistula.

Patients and Method

A retrospective review of records in children who had undergone removal of gastrostomy device between 2007-2011 was performed. Persistent gastrocutaneous fistula was defined as the absence of closure of the gastrostomy one month after device removal. Factors that might be predictive for the development of a persistent gastrocutaneous fistula were studied, including age, sex, underlying disease, method of gastrostomy insertion, duration of gastrostomy device in place, and complications related to the presence of gastrostomy.

Results

A total of 66 children were included in the study. Of these, 15 developed a persistent gastrocutaneous fistula (23%). Three predictive factors were identified with significant risk. The median length of time that the gastrostomy device had been in place prior to removal was significantly longer in children who developed persistent gastrocutaneous fistula than those with spontaneous closure - 50 months (range 18-96) vs. 26 months (range 2-144), respectively, P <0.008. Age over 6 years at the time of gastrostomy removal was the second significant risk factor (P <0.003) for development of persistent gastrocutaneous fistula. The third predictive factor was being a female gender (85% of children with persistent gastrocutaneous fistula, P <0.03). No significant association was found regarding the underlying disease, method of gastrostomy insertion or complications related to gastrostomy.

Conclusions

Persistent gastrocutaneous fistula is a common complication. Duration of gastrostomy device in place, age of the patient at time of removal and female gender were identified as significant predictive factors for development of persistent gastrocutaneous fistula.

 Key words: persistent gastrocutaneous fistula, gastrostomy device removal, complications post gastrostomy.


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