Abstract
Aim U-stitch laparoscopic gastrostomy is a commonly used technique for placement of balloon
gastrostomy for pediatric patients. The U-stitch method was modified by others whereby
the stay sutures are placed in a subcutaneous tissue. Although this modification has
been reported to be superior, it has led to suture knot abscess formation which was
not reported in the original method. We developed further modification whereby the
stay-suture knots are positioned within the gastrostomy tract instead of the subcutaneous
tissue which minimizes suture knot abscess formation.
Methods Modified U-stitch technique was used to place the balloon gastrostomy. The U-stitch
stay sutures are placed to hold the stomach to the abdominal wall. These sutures are
subcutaneously tunneled toward the gastrostomy tract and tied to the opposing sutures
with the resulting knots lying within the tract of the gastrostomy. Chart reviews
of patients who underwent this modified U-stitch method were done.
Results A total of 27 consecutive patients were evaluated. Minimal follow-up period was 6
months. No suture knot abscess complication was found. One patient for whom we used
a polyglactin (Vicryl; Ethicon Inc., Cincinnati, Ohio, United States) suture developed
cellulitis around the gastrostomy site which cleared with antibiotic. Remaining 10
patients for whom we used Vicryl suture and 16 patients for whom polydioxanone (PDS;
Ethicon Inc.) suture was used did not develop any infections.
Conclusion Subcutaneous placement of stay suture within the open gastrostomy tract rather than
within closed subcutaneous tissue may minimize suture knot abscess formation.
Keywords
laparoscopic gastrostomy - suture knot abscess - U-stitch laparoscopic gastrostomy
