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Skogar ML, Sundbom M. Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades. World J Gastroenterol 2024; 30:1358-1367. [PMID: 38596497 PMCID: PMC11000080 DOI: 10.3748/wjg.v30.i10.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children, respectively, requiring long-term enteral nutrition support. Procedure-related mortality is a rare event, often reported to be zero in smaller studies. National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature. AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term (< 30 d) and long-term survival. METHODS In this retrospective, population-based cohort study, individuals that had received a gastrostomy between 1998-2019 in Sweden were included. Individuals were identified in the Swedish National Patient Register, and survival analysis was possible by cross-referencing the Swedish Death Register. The cohort was divided into three age groups: Children (0-18 years); adults (19-64 years); and elderly (≥ 65 years). Kaplan-Meier with log-rank test and Cox regression were used for survival analysis. RESULTS In total 48682 individuals (52% males, average age 60.9 ± 25.3 years) were identified. The cohort consisted of 12.0% children, 29.5% adults, and 58.5% elderly. An increased use of gastrostomies was observed during the study period, from 13.7/100000 to 22.3/100000 individuals (P < 0.001). The use of PEG more than doubled (about 800 to 1800/year), with a corresponding decrease in open gastrostomy (about 700 to 340/year). Laparoscopic gastrostomy increased more than ten-fold (about 20 to 240/year). Overall, PEG, open gastrostomy, and laparoscopic gastrostomy constituted 70.0% (n = 34060), 23.3% (n = 11336), and 4.9% (n = 2404), respectively. Procedure-related mortality was 0.1% (n = 44) overall (PEG: 0.05%, open: 0.24%, laparoscopic: 0.04%). The overall 30-d mortality rate was 10.0% (PEG: 9.8%, open: 12.4%, laparoscopic: 1.7%) and decreased from 11.6% in 1998-2009 vs 8.5% in 2010-2019 (P < 0.001). One-year and ten-year survival rates for children, adults, and elderly were 93.7%, 67.5%, and 42.1% and 79.9%, 39.2%, and 6.8%, respectively. The most common causes of death were malignancies and cardiovascular and respiratory diseases. CONCLUSION The annual use of gastrostomies in Sweden increased during the study period, with a shift towards more minimally invasive procedures. Although procedure-related death was rare, the overall 30-d mortality rate was high (10%). To overcome this, we believe that patient selection should be improved.
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Affiliation(s)
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
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Naji H, Gheewale A, Safi E, Tuma F. Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study. BMC Surg 2022; 22:61. [PMID: 35193601 PMCID: PMC8862243 DOI: 10.1186/s12893-022-01515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background With gastrostomy becoming a common surgical procedure within the pediatric population surgeons continued to introduce modifications on the procedure to overcome some of the challenges and minimize complications. Modified U-stitches laparoscopic gastrostomy is gaining favor in some centers including the center of this study. Hence, this study was conducted to evaluate and compare its outcomes. Methods Eighty-nine gastrostomy procedures performed between 2013 and 2020 were reviewed to evaluate the surgical outcomes of a novel modified U-stitches laparoscopic gastrostomy (MLG) to the standard laparoscopic gastrostomy (LG) in children. The main outcome measured is the rate of postoperative complications encompassing dislodgement of gastrostomy button, leak around button, local infection, and development of granulation tissue post-surgery which is compared between the two population groups. Results The rate of leak around the button was found to be significantly less in the MLG (4%) compared to (15%) in the traditional LG approach with a p-value of 0.03. However, the overall complication rate for MGL is 63%; while it is 73% for LG. Conclusions The modified U-stitches laparoscopic gastrostomy has a lower rate of complications in comparison to the standard laparoscopic gastrostomy making it a preferred technique for gastrostomy placement in children.
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Affiliation(s)
- Hussein Naji
- Mediclinic Parkview Hospital, Dubai, UAE.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Aafia Gheewale
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.
| | - Ebtesam Safi
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Faiz Tuma
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Kvello M, Knatten CK, Bjørnland K. Laparoscopic Gastrostomy Placement in Children Has Few Major, but Many Minor Early Complications. Eur J Pediatr Surg 2020; 30:548-553. [PMID: 31891947 DOI: 10.1055/s-0039-3401988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Laparoscopic gastrostomy (LAPG) is an increasingly popular alternative to more traditional gastrostomy techniques. This study evaluates early postoperative complications following LAPG and investigates risk factors for gastrostomy complications. MATERIALS AND METHODS Retrospective study of patients <16 years undergoing LAPG from 2005 to 2018. Early postoperative complications (<30 days) were grouped as gastrostomy-related or general and graded according to the Clavien-Dindo classification for surgical complications. RESULTS A total of 104 patients, of which 54 (52%) had neurological impairment (NI), were included. Median age and weight were 1.2 years (1 day-15.2 years) and 8.9 kg (3.4-36), respectively. Operating time was median 37 minutes (19-86) and shorter in the second half of the patients (46 vs. 35 minutes, p = 0.04). A total of 40 (38%) patients experienced 53 gastrostomy-related complications. Of these, seven complications needed surgical treatment; severe leakage (2), too short gastrostomy button (1), feeding difficulties (1), gastric outlet obstruction (1), omentum trapped in umbilical port sutures (1), and suspected fascial defect (1). Stoma infection and granulation tissue were reported in 13 and 12%, respectively. Tube dislodgement occurred in six patients and was managed with bedside reinsertion in all. Gastrostomy-related complications were less frequent in NI patients (46 vs 22%, p = 0.01). CONCLUSION LAPG is a safe procedure with few major complications, but a high rate of minor complications. Operating time declined during the study period, and NI patients had fewer gastrostomy-related complications.
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Affiliation(s)
- Morten Kvello
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Kristin Bjørnland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
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Burman L, Diaz M, Viktorsdóttir MB, Sjövie H, Stenström P, Salö M, Arnbjörnsson EÓ. Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants. Surg J (N Y) 2019; 5:e96-e102. [PMID: 31508490 PMCID: PMC6727022 DOI: 10.1055/s-0039-1696731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
Background
Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved.
Methods
Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures.
Results
The 141 included infants underwent surgery at a median age of 10 months (range: 1–24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4–30). The most common microbes discovered were skin bacteria
Staphylococcus aureus
or
Streptococcus pyogenes
, but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis.
Conclusion
Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.
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Affiliation(s)
- Linnéa Burman
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden
| | - Maia Diaz
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden
| | - Margrét Brands Viktorsdóttir
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden
| | - Helen Sjövie
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden
| | - Pernilla Stenström
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden
| | - Martin Salö
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden
| | - Einar Ólafur Arnbjörnsson
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Pediatric Surgery, Lund, Sweden
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Sandberg F, Viktorsdóttir MB, Salö M, Stenström P, Arnbjörnsson E. Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis. Pediatr Surg Int 2018; 34:1321-1327. [PMID: 30291404 PMCID: PMC6244983 DOI: 10.1007/s00383-018-4358-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE A meta-analysis was performed to compare the rates of the major complications associated with two gastrostomy tube placement techniques in a pediatric population: laparoscopy-assisted gastrostomy (LAG) and percutaneous endoscopic gastrostomy (PEG). METHODS The PubMed electronic database was queried for comparative studies of the two insertion techniques. The Newcastle-Ottawa scale (NOS) was used for the assessment of the quality and risk of bias in the included studies. The main outcome measure was the frequency of major complications defined as the need for reoperation within 30 days or death. RevMan 5.3, was used, with a p < 0.05 indicating statistical significance. RESULTS Eight studies including 1550 patients met the inclusion criteria. The risk for major complications was higher in PEG than in LAG 3.86 (95% confidence interval 1.90-7.81; p < 0.0002). The number needed to treat to reduce one major complication by performing LAG instead of PEG was 23. There were no randomized-controlled trials. Overall, the quality of the included studies was determined to be unsatisfactory. CONCLUSIONS PEG placement was associated with a significantly higher risk of major complications compared to LAG placement. Therefore, LAG should be the preferred method for gastrostomy tube placement in children.
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Affiliation(s)
- Filip Sandberg
- 0000 0004 0623 9987grid.411843.bDepartment of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden ,0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Margrét Brands Viktorsdóttir
- 0000 0004 0623 9987grid.411843.bDepartment of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden ,0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Martin Salö
- 0000 0004 0623 9987grid.411843.bDepartment of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden ,0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Pernilla Stenström
- 0000 0004 0623 9987grid.411843.bDepartment of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden ,0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Einar Arnbjörnsson
- 0000 0004 0623 9987grid.411843.bDepartment of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden ,0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
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Abstract
PURPOSE The aims of this study were to assess the short- and long-term complication rates after video-assisted gastrostomy (VAG), the effects of age and gender on long-term complications and the effect of duration of gastrostomy tube retention on the need for gastroraphy when the gastrostomy device was removed. METHODS This was a retrospective study of children undergoing VAG at a single institution. Children who died or moved from the area were excluded. The rates of short- and long-term complications developing at 3-6 months or 2 or more years, respectively, were compared. RESULTS A total of 170 children were studied, out of a cohort of 303 children. The median age at surgery was 2 years. The median duration of postoperative long-term follow-up was 5 years (2-9 years). The complications at the respective short and long-term follow-ups were as follows: granulation tissue, leakage, infection and vomiting. There were no differences in the short- versus long-term complication rates for gender and age. Children needing gastroraphy had used a gastrostomy device significantly longer compared with children with spontaneous closure. CONCLUSION Complications after VAG decrease over time. A longer duration of gastrostomy device retention leads to increased need for gastroraphy.
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Kapadia MZ, Joachim KC, Balasingham C, Cohen E, Mahant S, Nelson K, Maguire JL, Guttmann A, Offringa M. A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review. Pediatrics 2016; 138:peds.2015-3967. [PMID: 27365302 DOI: 10.1542/peds.2015-3967] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting. OBJECTIVE To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes. DATA SOURCES Medline, Embase, and Cochrane Register databases searched from inception to March 2014. STUDY SELECTION Articles examining health outcomes of neurologically impaired children living with feeding tubes. DATA EXTRACTION Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development. RESULTS We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes. LIMITATIONS We were unable to investigate effect size of outcomes because quantitative data were not collected. CONCLUSIONS The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS.
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Affiliation(s)
- Mufiza Z Kapadia
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences,
| | - Kariym C Joachim
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Chrinna Balasingham
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Eyal Cohen
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Sanjay Mahant
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Katherine Nelson
- Division of Paediatric Medicine, Institute of Health Policy, Management and Evaluation, and Paediatric Advanced Care Team, Department of Paediatrics, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, and Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Martin Offringa
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
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8
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Abstract
PURPOSE Laparoscopic gastrostomy (LAPG) has gained popularity in children. The aim of this study was to compare the outcome of LAPG versus open gastrostomy (OG) in children with focus on complications, operative times and postoperative length of stay. METHODS Retrospective study of children who had gastrostomies inserted at our tertiary Pediatric Surgery Center from 2000 until 2013. The indications for a gastrostomy were an anticipated need for enteral support for at least 6 months. Totally 243 children were included in the study, 83 with LAPG and 160 with OG. RESULTS We found a significant difference in postoperative length of stay, 3 days in the LAPG group versus 4 days in the OG group but no difference in a sub-group analysis from 2010 to 2013 when both techniques were used. There was no difference in median operative time or complications rates. Granuloma was the dominating complication in both groups. CONCLUSION These two feeding-access techniques are comparable regarding complications, operative times and postoperative length of stay. The choice of surgical method should be individualized based on the patient's characteristics and the experience of the surgeon. The favorable results with LAPG in adults are not necessarily transferable to children since there are physiological and anatomical differences.
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Gastroscopy in pediatric surgery: indications, complications, outcomes, and ethical aspects. Gastroenterol Res Pract 2015; 2015:820340. [PMID: 25883646 PMCID: PMC4389833 DOI: 10.1155/2015/820340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of this study was to map gastroscopies performed at a single tertiary pediatric surgery centre to investigate indications, complications, outcomes, and ethical aspects. Material and Methods. A retrospective study of gastroscopies performed during two time periods (2001-2004 and 2011-2014) was conducted. Data regarding indications, outcomes, and complications of pediatric gastroscopies were analysed from a prospectively collected database. Results. The indications for gastroscopies changed over time. Therefore, 376 gastroscopies performed from 2011 through 2014 were studied separately. The median patient was four years old. The predominant indications were laparoscopic gastrostomy (40%), investigation of gastroenterological conditions (22%), obstruction in the upper gastrointestinal tract (20%), gastroesophageal reflux disease (GERD) (15%), and other indications (3%). Percentages of gastroscopies with no positive findings for each condition were laparoscopic gastrostomy, 100%; gastroenterological conditions, 46%; obstruction in the upper gastrointestinal tract, 36%; GERD, 51%. Furthermore, gastroscopies did not lead to any further action or change in treatment in 45% of gastroenterological conditions and 72% of GERD cases. The overall complication rate was 1%. Conclusion. The results are valuable to educate pediatric surgeons and to inform health care planning when including gastroscopy within clinical practice.
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Göthberg G, Björnsson S. One-Step Insertion of Low-Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy. JPEN J Parenter Enteral Nutr 2015; 40:423-30. [DOI: 10.1177/0148607114567202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Gunnar Göthberg
- Department of Pediatric Surgery, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Sigge Björnsson
- Department of Pediatric Surgery, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
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Pre- and postoperative vomiting in children undergoing video-assisted gastrostomy tube placement. Surg Res Pract 2014; 2014:871325. [PMID: 25379563 PMCID: PMC4208457 DOI: 10.1155/2014/871325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/12/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of this study was to determine the incidence of pre- and postoperative vomiting in children undergoing a Video-Assisted Gastrostomy (VAG) operation. Patients and Methods. 180 children underwent a VAG operation and were subdivided into groups based on their underlying diagnosis. An anamnesis with respect to vomiting was taken from each of the children's parents before the operation. After the VAG operation, all patients were followed prospectively at one and six months after surgery. All complications including vomiting were documented according to a standardized protocol. Results. Vomiting occurred preoperatively in 51 children (28%). One month after surgery the incidence was 43 (24%) in the same group of children and six months after it was found in 40 (22%). There was a difference in vomiting frequency both pre- and postoperatively between the children in the groups with different diagnoses included in the study. No difference was noted in pre- and postoperative vomiting frequency within each specific diagnosis group. Conclusion. The preoperative vomiting symptoms persisted after the VAG operation. Neurologically impaired children had a higher incidence of vomiting than patients with other diagnoses, a well-known fact, probably due to their underlying diagnosis and not the VAG operation. This information is useful in preoperative counselling.
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