Erin Brown, Pablo Laje
Children's Hospital of Philadelphia, Philadelphia, USA


Aim of the Study: Gastrocutaneous fistulas (GCF) are relatively common after gastrostomy tube removal in children. The aim of this study was to evaluate the safety and efficacy of an extraperitoneal GCF closure technique based on the use of a stapling device, and compare the outcomes with the standard extraperitoneal hand-sewn technique. 

Methods: We retrospectively reviewed all extraperitoneal GCF closures done with either the stapled technique or the hand-sewn technique between June/2015 and November/2017. In both techniques an elliptical incision was made around the GCF, and the core of the GCF was dissected circumferentially off the subcutaneous tissue and the abdominal wall muscles until the posterior sheath of the abdominal wall muscles was exposed. The peritoneal cavity was not entered. In the stapled technique a stapling device was fired across the core of the GCF (Figure). In the hand-sewn technique the GCF was closed with interrupted stitches. In both techniques the stump of the GCF was covered by closing all layers of the abdominal wall. The technique chosen for each case was based on surgeon’s preference.

Main Results: We reviewed 138 GCF closures, 39 with the stapled technique and 99 with the hand-sewn technique. Mean age was 6 (1 to 17) years in the stapled group and 7 (1 to 24) years in the hand-sewn group (p: 0.124). The mean operative time was 34 (SD: 8.5) minutes in the stapled group and 32 (SD: 10.4) minutes in the hand-sewn group (p: 0.169). On a follow up period of 2 to 30 months there have been no GCF recurrences on either group. There were no re-admissions for postoperative infection or wound dehiscence in either group.  

Conclusion: The stapled technique is a safe and efficient option for the closure of GCF and has similar outcomes compared to the hand-sewn technique.