Laparoscopic gastrostomy associated with better outcomes than open gastrostomy in adults

Major finding: Open gastrostomy patients were found to have 4.5 times as many renal complications, twice as many wound events, and 50% more pulmonary complications than laparoscopic gastrostomy patients.

Data source: Retrospective study of 2005-2010 NSQIP database of 2,883 patients aged 18 years or older who underwent either open, laparoscopic, or percutaneous endoscopic gastrostomy.

Disclosures: Dr. Van Dusen did not have any relevant disclosures.



WASHINGTON – Laparoscopic gastrostomy in adults was associated with fewer complications than open gastrostomy in the same population, according to data presented at the annual clinical congress of the American College of Surgeons.

In a retrospective study of data from 2,883 patients, taken from the 2005-2010 National Surgical Quality Improvement Program (NSQIP) database, Dr. Rachel Van Dusen and her colleagues reviewed a variety of outcomes, including wound, pulmonary, renal, cardiac, and thromboembolic, in patients who underwent either a laparoscopic (n = 382), open (n = 2,112), or percutaneous endoscopic gastrostomy (PEG) (n = 389).

Either laparoscopic or open gastrostomies are performed in patients for whom PEG, the standard of care, is unfeasible. Dr. Van Dusen, of George Washington University, Washington, said that theirs was the first study to measure the association between all three procedures and complications in the adult gastrostomy patient population.

The average age of patients was 58 years in the laparoscopic cohort, 62 years in the open group, and 65 years in the PEG group. The patients were at least 18 years old. The laparoscopic group was 88.8% white and 69.4% female; the open group, 80.7% white and 58.2% female; and the PEG group, 85.2% and 57.6%, respectively.

A stepwise logistic regression analysis of patient characteristics in all three cohorts indicated that at baseline, open gastrostomy patients tended, among other factors, to have serum albumin levels less than 3 g/dL (44%), sepsis (35.7%), diabetes (20.4%), a body mass index of 20 kg/m2 or less (27.8%), and ascites (9.0%); in addition, 27% of patients were undergoing chemotherapy.

In a similar analysis, laparoscopic patients were seen to be less ill at baseline: Only 20.4% had low albumin levels, diabetes and sepsis levels were just under 16%, BMI was between 20 and 40, 2.9% were ascitic, and only 1.3% were receiving chemotherapy.

Complications in each group were reviewed according to either wound or organ system. PEG patients had the fewest overall complications (22.4%), with none that were comparatively significant. However, there were several significant differences in complication rates between the laparoscopic and open gastrostomy cohorts.

Pulmonary complications occurred in 23.2% of the open gastrostomy group, compared with 9.7% of the laparoscopic group (multivariate odds ratio, 1.97). Also in the open gastrostomy group, 2.5% had renal complications, compared with 0.5% of the laparoscopic patients (mOR, 4.48). Sepsis was found in 13.5% of the open group and 5.8% of the laparoscopic group (mOR 1.72).

Open gastrostomy patients, when compared with the PEG group, had twice the odds of experiencing wound events (mOR, 2.10) and a 1.5 times greater chance of having sepsis (mOR, 1.51). No significant differences were found between other complications.

"We surmise that the reason the higher rate of infection was associated with the open gastrostomy [patients] is the increase in fascial violation and the exposure of the soft tissues," said Dr. Van Dusen. "The increase in pulmonary problems may be related to poor pulmonary toilet from more postoperative pain, and more septic issues may be related to more significant fluid shifts during laparotomy."

Dr. Van Dusen concluded that while PEG remains the best method of enteral access, laparoscopic gastrostomy is superior to open gastrostomy.

Dr. Van Dusen did not have any relevant disclosures.

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