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Gastrostomy, gastrojejunostomy and anti-reflux surgery in infants and children who are chronically ventilator dependent are associated with significant risk of morbidity and mortality. We report outcomes of 22 high risk children who underwent these procedures at our centre. Pre-operative investigations included: overnight oxygen and carbon dioxide monitoring and subsequent optimisation of ventilatory support, echocardiography, video fluoroscopy, and assessment of gastroesophageal reflux. We carried out 24 procedures under general anaesthesia. Twenty-one children used ventilatory support pre-operatively. Median age of first surgical procedure was 18 months (range 3-180). Supplementary feeding was commenced in 20 children prior to procedure, median age 9 months (1-31). Median PICU length of stay was 1 (1-8) days. No children died in the post-operative period. Extubation was possible within 24h in 87% of cases. Complications included; atelectasis (n=2), ileus (n=2), abdominal distension (n=4) and loose stools (n=1). We conclude that, in this high risk cohort of ventilator dependent children with predominantly neuromuscular disorders, with careful assessment, operative intervention can be carried out under general anaesthesia, with the child being extubated early back onto their routine ventilatory support and aggressive airway clearance. Additionally this protocol can minimise post-operative complications and is associated with a good outcome in the majority., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and minimally invasive surgical method for providing enteral access in children. In pediatrics, the indications for PEG placement frequently include malnutrition or failure to thrive, as well as oropharyngeal dysphagia, especially in children with neurological impairment (NI). The risk for postoperative complications is low. However, among children with NI, gastroesophageal reflux disease (GERD) may necessitate fundoplication prior to gastrostomy tube placement. Preoperative pH probe testing has not been shown to be an effective screening tool prior to PEG placement among patients with GERD. Laparoscopic gastrostomy tube insertion was introduced in pediatric patients in an attempt to decrease complications associated with PEG. Although outcomes were reported to be similar to or better than PEG alone, future comparative studies are needed to better define the optimal patient demographic for this technique., (© Springer Science+Business Media, LLC 2011)

Background: Feeding through tubes placed in the intestine is a useful way of nutritional support in a patient who is unable to eat but has a well functioning gastrointestinal system. Till 1980, the acceptable technique to place a gastrostomy tube was surgical. However, in the past twenty years percutaneous endoscopic gastrostomy (PEG) has replaced surgical gastrostomy in most settings., Goals: In this study we explored the indications, the age of the patients, the conditions in which the procedure took place and its outcome in children. The study aimed to investigate the effectiveness of this method in children., Methods: The data was gathered retrospectively according to information found in the files and a questionnaire the parents answered. Fifty-two children from the Tel Aviv Medical Center and from the Sheba Medical Center who underwent a PEG procedure were studied. The data gathered from the study included age, gender, origin, sequence of the procedure, indications, place, performers, complications and the effectiveness of the method according to parents' satisfaction and weight of the patient. In addition, the following parameters were studied: type of anesthesia, sort of antibiotics that were provided, number of cases in which enteral nutrition was given permanently or temporarily, type of formula that was given and the way it was introduced, number of failures and fundoplications., Results: Mean age of the children was 5.4 years. Ninety six percent of the procedures succeeded. The most common indications were failure to thrive (35%) and neurological disorders. In 56% of cases the performer was a gastroenterologist alone. When the procedures were performed by gastroenterologists, a lower rate of complications was seen than with a gastroenterologist and a surgeon (20.8% vs. 52.6% accordingly). In 57% of the children there were no complications observed. In addition, most of the complications which were observed were minor (abdominal pain, nausea and vomiting and reflux)., Conclusions: According to this study we concluded that PEG is a minimally invasive technique, associated with a low rate of severe complications and provides significant support for children who need enteral nutrition.

Objective: To document catch-up growth in children in the first 18 months after gastrostomy surgery and characterize how weight and length growth differ according to medical and nutritional risks., Design: Repeated measures study to evaluate weight and linear growth in gastrostomy-fed children., Subjects/setting: Seventy-five subject met the selection criteria; gastrostomy placement anytime from birth to age 6.5 years, diagnosis of failure to thrive before gastrostomy. surgery, absence of nonmedical barriers to adequate nutrition. Children were seen in specialty outpatient clinics., Outcome Measures: Three measurements of weight and length: at the time of surgery and 12 and 18 months after surgery., Statistical Analyses: Paired t tests of z scores were used to determine catch-up growth. Analysis of variance used variables (age of placement, ambulatory status, prematurity, mode of feeding) to determine statistically significant predictors of growth., Results: After gastrostomy surgery, catch-up growth was observed in height and weight for children regardless of prematurity or age at the time of gastrostomy placement. Ambulatory children did not achieve catch-up growth, but nonambulatory children did. At 18 months after surgery, catch-up growth occurred in children whose sole source of nutrition was through occurred in children whose sole source of nutrition was through the gastrostomy, as well as in those who were able to receive nutrition by mouth. Children with a diagnosis of cerebral palsy experienced better growth than children with other diagnoses. CONCLUSION/APPLICATION: Failure to thrive in children up to age 6.6 years can be corrected when adequate nutrition is provided. Benefits of gastrostomy surgery observed in catch-up growth reinforce the importance of medical nutrition therapy.