Revision of long-term gastrostomy.

PURPOSE: Insertion of gastrostomy has become a popular choice for children with feeding problems. With the passage of time, gastrostomies require revision for various reasons. The aims of the present study are to report our experience of the revision of long-term gastrostomies, to ascertain the reasons for revision, and to discuss any measures that may prevent the need for revision. METHODS: We conducted a retrospective review of all of the patients requiring gastrostomy revision by the senior author between 2005 and June 2011. The patients had had their original operation in several different hospitals within the United Kingdom, between 1997 and 2008. We excluded those patients requiring the revision for an acute complication (within 1 month) or required revision for subsequent fundoplication. The patients' hospital notes were reviewed to identify the reasons for revision and a literature search was done to find ways to prevent these. RESULTS: There were 15 patients who required revision of gastrostomy. Epithelialisation of the gastrostomy track with gastric mucosa was the most common cause (9/15). Other reasons were buried bumper syndrome (BBS) (4/15) and migration of the gastrostomy exit site toward the rib cage (2/15). The mean interval before revision due to the epithelialisation of the tract was 101 months since the insertion of the gastrostomy. The mean for other complications was 26 months for BBS and 95 months for migration of the exit site. CONCLUSIONS: We believe that the incidence of gastrostomy revision could be reduced. Preventing epithelialisation is difficult and may be minimised by aggressive and generous use of topical silver nitrate. The gastrostomy exit site needs to be as far away from the rib edge as possible. Checking the bumper regularly or use of a gastrostomy balloon button instead of a tube eliminates BBS. Parents need to be aware of the possibility that a long-term gastrostomy may need surgical revision.

Postnatal rupture of an antenatally diagnosed choledochal cyst: first case report.

UNLABELLED: A 7-mo-old girl with an asymptomatic antenatally diagnosed choledochal cyst was referred to the regional paediatric surgical centre for advice on management. Following further radiological investigation and discussion with the supra-regional centre, a date for elective surgery was arranged. However, in the interim, she was admitted as an emergency following rupture of the cyst. She made an uneventful recovery following urgent laparotomy. CONCLUSION: We recommend prompt paediatric surgical referral following antenatal diagnosis of a presumed choledochal cyst. Delay in surgery may permit expansion and rupture of the cyst, even after a period of asymptomatic stability.