Primary laparoscopic gastrojejunostomy tubes as a feeding modality in the pediatric population

Abstract Purpose Outcomes associated with primary laparoscopic gastrojejunal (GJ) tube placement in the pediatric population were evaluated. Methods A single-institution, retrospective review examined patients undergoing laparoscopic GJ tube placement between June 2011 and December 2014. Outcomes included gastric feeding tolerance, subsequent fundoplication, complications, and mortality. Results Ninety laparoscopic GJ tubes were placed. Median follow-up was 342 days (interquartile range [IQR] = 141–561 days). Median patient age was 5 months (IQR = 3–11 months) and weight was 5.2 kg (IQR = 4–8.4 kg). The most common indications for placement were gastroesophageal reflux (n = 85, 94.4%) and/or aspiration (n = 40, 44.4%). Most common comorbidities included cardiac (n = 34, 37.8%) and respiratory (n = 29, 32.2%) diseases. The complication rate was 17.8%, including one case of intestinal perforation. Thirty-four (37.7%) patients transitioned to gastric feeding within 1 year; time to conversion was 156 days (IQR = 117–210 days); of those, 18.9% patients transitioned to oral feedings. A fundoplication was later performed in 4 children for persistent reflux. Mortality was 23.3% with no procedural-related deaths. Conclusion Primary laparoscopically placed GJ tubes are a reliable means of enteral access for pediatric patients with gastric feeding intolerance. Many of these children are successfully transitioned to gastric and/or oral feedings over time. Further studies are needed to characterize which patients are best served with a GJ tube versus alternatives such as fundoplication. Level of evidence III (treatment) Type of study Retrospective