A method for preventing failure of minimally invasive gastrostomy in children: a case series

BACKGROUND: In recent years, minimally invasive gastrostomy using low-profile MIC-KEY gastrostomy tubes has been increasingly used to provide palliative care for children. Despite the advantages of minimally invasive gastrostomy placement, as with any surgical intervention, the rate of postoperative complications reaches 11.1%–46.9%. One of these complications is gastrostomy failure.

AIM: The work aimed to develop a method for preventing failure of minimally invasive gastrostomy in children receiving palliative care and to evaluate its effectiveness.

METHODS: From 2020 to 2024, 27 children with palliative status, body weight deficit, and indications for gastrostomy placement were admitted to the surgical department. At admission, all patients were assessed as being in severe condition. The cohort included 18 (66.7%) boys and 9 (33.3%) girls aged 1 month to 13 years. The inclusion criteria were children with palliative status and indications for gastrostomy placement. The study group included 16 children who underwent minimally invasive gastrostomy using the push technique with primary placement of a high-profile gastrostomy tube with external and internal retainers (MIC-KEY) in 2023–2024. After 6 months, the high-profile gastrostomy tube was replaced with a low-profile MIC-KEY gastrostomy tube of the required length and diameter. The control group included 11 children who underwent minimally invasive gastrostomy using the push technique with primary placement of a low-profile MIC-KEY tube in 2020–2022. In both groups, body weight and the length and diameter of the gastrostomy tract were measured at the time of gastrostomy placement and after 6 months.

RESULTS: In the study group, despite changes in gastrostomy tract parameters from baseline in some children (a decrease in length and an increase in diameter), no gastrostomy failure occurred, whereas in the control group, with similar parameter changes, the failure rate was 72.7%. The method of temporary external fixation of the low-profile gastrostomy tube allowed for a sufficiently long interval for delivery of an appropriately sized tube without gastrostomy failure. The use of an algorithm with primary placement of a high-profile gastrostomy tube followed by its planned replacement with a low-profile tube after 6 months in the formed gastrostomy tract may prevent gastrostomy failure and avoid financial losses.

CONCLUSION: The proposed algorithm for using MIC-KEY gastrostomy tubes for minimally invasive gastrostomy was found to be both effective and cost-efficient. The use of a technical approach with an elastic silicone tube eliminates play of the low-profile MIC-KEY gastrostomy tube and prevents gastrostomy failure.