Outpatient curettage and electrocautery as an alternative to primary surgical closure for pediatric gastrocutaneous fistulae

• Published in: The Journal of surgical research 2018-09, Vol.229, p.96-101
• Main Authors: Denning, Naomi-Liza, Abd El-Shafy, Ibrahim, Hagen, John, Stylianos, Steven, Prince, Jose M., Lipskar, Aaron M.
• Format: Article
• Language: English
• Subjects: Adolescent; Ambulatory Surgical Procedures - adverse effects; Ambulatory Surgical Procedures - methods; Child; Child, Preschool; Curettage; Curettage - adverse effects; Curettage - methods; Cutaneous Fistula - etiology; Cutaneous Fistula - surgery; Electrocautery; Electrocoagulation - adverse effects; Electrocoagulation - methods; Female; Gastric Fistula - etiology; Gastric Fistula - surgery; Gastrocutaneous fistula; Gastrostomy; Gastrostomy - adverse effects; Humans; Male; Operative Time; Patient Selection; Pediatric; Postoperative Complications - etiology; Postoperative Complications - surgery; Recovery Room - statistics & numerical data; Retrospective Studies; Treatment Outcome
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2018.03.037

The development of a gastrocutaneous fistula (GCF) after gastrostomy tube removal is a frequent complication that occurs 5%-45% of the time. Conservative therapy with chemical cauterization is frequently unsuccessful, and surgical GCF repair with open primary layered closure of the gastrotomy is often required. We describe an alternative approach of GCF closure that is an outpatient, less invasive procedure that allows patients to avoid the comorbidities of general endotracheal anesthesia and intraabdominal surgery. This is an Institutional Review Board approved retrospective review of all patients who underwent GCF closure from January 2010 to July 2016 at a tertiary care children's hospital. Demographics including age, weight, body mass index, comorbidities, and initial indication for gastrostomy tube were recorded. Operative details such as ASA score, operative duration, type of anesthesia, and airway were noted. Based on surgeon preference, two types of operative closure were used during that time frame: primary layered closure or curettage and cautery (C&C). The latter is a procedure in which the fistula tract is first scraped with a fine curette, and then the fistula opening and tract are cauterized circumferentially. Finally, the presence of a persistent fistula and the need for formal reoperation were determined. Sixty-five unique patients requiring GCF closure were identified. Of those, 44 patients (67.6%) underwent primary closure and 21 patients (32.3%) underwent C&C. The success rate of primary closure was 97% with one patient experiencing wound breakdown with persistent fistula. The overall success rate of C&C was 66.7% (14/21). Among those 14 patients, 11 (52.4%) GCF patients were closed by 1 mo. An additional two patients’ gastrocutaneous fistulae were closed by 4 mo (61.9%). One GCF was successfully closed with a second C&C procedure. Seven of the 21 patients (33.3%) required subsequent formal layered surgical closure. C&C had significantly shorter operative times (13.5 ± 14.7 min versus 93.4 ± 61.8, P