P1.071: Gastrostomy Tube Dislodgement Following Gastrostomy Tube Button Placement: A Single-Institution Retrospective Analysis

Background: Gastrostomy tube complication rates range from 14-83%, with tube dislodgements occurring in 10-43% of cases. Understanding the incidence and consequences of these complications is necessary for proper preoperative guidance and to optimize perioperative practice. Due to the wide variability in complication rates, we aimed to quantify the incidence of gastrostomy tube dislodgements at our institution and identify contributing factors.

Methods: We performed a single-institution retrospective review of all patients < 18 years old who underwent initial surgical gastrostomy tube button placement between January 2022 and August 2024. We performed descriptive statistics, univariate analysis, and Cox regression analysis, with the primary outcome measure of any gastrostomy tube dislodgement. We defined statistical significance using two-sided tests as p< 0.05.

Results: 374 patients (54.8% male) underwent gastrostomy tube placement. The median age was 9.6 months and patients were followed for a median of 18.4 months. Two types of gastrostomy tubes were used: the MINIone balloon button (34.2%) and the MIC-KEY low-profile gastrostomy (65.8%). Nearly all cases were performed laparoscopically (98.1%). Two techniques were used for laparoscopic gastrostomy tube placement: the transfascial temporary fixation technique (TTFT) (83.5%) and the subcutaneous stay suture technique (SSST) (16.5%) (Table 1). Transfascial temporary fixation involves fixing the stomach to the abdominal wall with two full-thickness U-stiches that are removed on postoperative day two; SSST involves placing two to four buried absorbable sutures to fix the stomach to the abdominal wall fascia.

230 patients (38.5%) experienced gastrostomy tube dislodgement, 42 (11.2%) experienced more than one dislodgment, and 16 (4.3%) required a return to the operating room (OR) due to tube dislodgement. No association between dislodgement and any demographic factor, operative technique, or gastrostomy tube type was observed (Table 1). Dislodgements that occurred within 30 days postoperatively were nearly twice as likely to need operative intervention than dislodgements that occurred beyond 30 days postoperatively (10.14% vs. 5.52%, p=0.25). On Cox regression analysis, controlling for surgical technique, earlier time to first dislodgement was associated with an increased risk of subsequent dislodgements (HR 0.996, 95% CI: 0.993-1.000, p< 0.001).

On subset analysis of laparoscopic cases, dislodgement rates were similar between the SSST and TTFT groups at 30 days postoperatively (14.0% vs 14.5%, respectively; p=0.92), and during the entire observation period (40.4% vs. 38.7%, respectively; p=0.81). No patients in the SSST group returned to the OR for tube replacement, while 15 patients in the TTFT group returned to the OR for tube replacement (0.0% vs. 8.2%, p=0.14) (Table 2).

Conclusion: Type of gastrostomy tube and operative technique are not associated with rates of gastrostomy tube dislodgement, but SSST had lower rates of reoperation once a tube is dislodged. Earlier dislodgements are associated with more frequent subsequent complications.