Jeffrey Lukish1, Louis Marmon, Christopher Burns. 1. Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University, Baltimore, Maryland 21287, USA. jlukish@jhu.edu
Abstract
UNLABELLED: A persistent gastrocutaneous fistula (pGCF) is an all-too-common complication following removal of a gastrostomy tube (GT) in a child and is associated with significant morbidity. The most common initial methods to manage pGCF include local would care and occlusion techniques. Failure of this approach is followed by surgical excision of the fistula tract and closure of the gastrostomy under general anesthesia. We report the first use of a tissue adhesive, 2-octylcyanoacrylate (2OC) (Dermabond; Ethicon, Sommerville, NJ) as a non-surgical method to close pGCF in children. METHODS: The families of children presenting to the pediatric surgical division for management of a pGCF were offered the option of 2OC closure. Children not receiving or who failed to achieve closure with 2OC therapy underwent surgery for excision of the pGCF with primary closure of the stomach and soft tissues. RESULTS: Seven children underwent 2OC therapy. 57% (4 of 7) of the children had complete closure of the pGCF with 2OC therapy. Three children underwent operative closure without complication. CONCLUSIONS: The tissue adhesive 2OC can successfully close a pGCF in children after GT removal. This therapy is cost-effective, non-invasive, does not require general anesthesia, and can be performed in an outpatient setting.
UNLABELLED: A persistent gastrocutaneous fistula (pGCF) is an all-too-common complication following removal of a gastrostomy tube (GT) in a child and is associated with significant morbidity. The most common initial methods to manage pGCF include local would care and occlusion techniques. Failure of this approach is followed by surgical excision of the fistula tract and closure of the gastrostomy under general anesthesia. We report the first use of a tissue adhesive, 2-octylcyanoacrylate (2OC) (Dermabond; Ethicon, Sommerville, NJ) as a non-surgical method to close pGCF in children. METHODS: The families of children presenting to the pediatric surgical division for management of a pGCF were offered the option of 2OC closure. Children not receiving or who failed to achieve closure with 2OC therapy underwent surgery for excision of the pGCF with primary closure of the stomach and soft tissues. RESULTS: Seven children underwent 2OC therapy. 57% (4 of 7) of the children had complete closure of the pGCF with 2OC therapy. Three children underwent operative closure without complication. CONCLUSIONS: The tissue adhesive 2OC can successfully close a pGCF in children after GT removal. This therapy is cost-effective, non-invasive, does not require general anesthesia, and can be performed in an outpatient setting.