Optimising Paediatric Gastrostomy Outcomes Through Appropriate Procedural Selection: A 10‐Year Retrospective Cohort Study

BACKGROUND: Gastrostomy is a common intervention for enteral nutrition in children. While originally an open procedure, techniques now include percutaneous endoscopic (PEG), laparoscopic (LAP) and laparoscopic-assisted PEG (LAPEG). This study compared outcomes across these four techniques over a 10-year period at a single tertiary paediatric centre. METHODS: A retrospective cohort study was conducted on all initial gastrostomies performed between January 2014 and September 2024. Data collected included patient demographics, clinical characteristics and procedural details. Primary outcomes were intra and postoperative complications. Secondary outcomes included procedure time, length of stay and gastrostomy-related readmission within 1 year. Statistical analysis utilised chi-squared, Fisher's exact tests and Kruskal-Wallis test. RESULTS: A total of 431 patients underwent gastrostomy (PEG = 318, LAPEG = 53, LAP = 36, Open = 24). PEG demonstrated the shortest procedure time, while Open gastrostomy was significantly longer (p < 0.05). Intraoperative complications were rare (2.3%) and did not differ significantly between techniques. Post-operative complication rates differed significantly (p = 0.036), being lowest in LAPEG (24.5%) and highest in Open (58.3%). Gastrostomy related postoperative complications did not differ significantly between groups (p = 0.112). CONCLUSION: PEG demonstrated increased efficiency for appropriately selected patients, while LAPEG and LAP were valuable options for cases requiring additional operative flexibility. Open gastrostomy retains an important role in patients whose complexity precludes minimally invasive methods. The comparable safety across techniques reflects the multidisciplinary approach to matching procedural complexity with patient needs, highlighting case selection as the key determinant of clinical outcomes.