From
StayCurrentMD
Update Course Rewind: Who to Send Home from the OR: Gastrostomy 2023
hosted by Dr. Cecilia Gigena
Chapter 1 of 6 · Case-Based Learning
Fistula closure case
Introduction and Case 1: Gastrocutaneous Fistula Closure
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
In Argentina, it's common practice to admit gastrocutaneous fistula closure patients to the floor and discharge them the next day.
Without proper separation and closure of gastrocutaneous fistula, there was perceived risk of refistulization through the abdominal wall, but in practice that doesn't seem to be a primary complication.
Historically, gastrostomy closure used to be done in the office with cautery, and patients were sent home from there, but not all of the fistulas closed properly.
About 80% of gastrocutaneous fistula closures in NSQIP were going home the same day versus 20% going home at day one or two or later.
If there are going to be wound complications after gastrocutaneous fistula closure, they typically aren't seen in the first 24 hours, so it's still safe to send patients home.
Setting the expectation with the family that gastrocutaneous fistula closure is a same day procedure helps with discharge planning.
Adequate pain control with scheduled Tylenol, ibuprofen, and potentially other adjuncts is important for same-day discharge after gastrocutaneous fistula closure.
In Poland, about 42% of surgeons kept lap G-tube patients overnight versus 41% who discharged when goal feeds were met somewhere between three and four hours.
Dr. Oyatunji and colleagues collected data on 62 patients who underwent laparoscopic gastrostomy tube placement and discharged 82% of these patients home on the same day as their procedure.
In Dr. Oyatunji's protocol, feeds were started within four hours after lap G-tube placement and patients were discharged home before reaching goal feeds.
98% of families expressed satisfaction with same-day discharge after lap G-tube placement in Dr. Oyatunji's series.
In Dr. Oyatunji's clinic, much of the teaching for G-tube placement is done pre-operatively with the dietician and nursing teams.
The ideal candidates for same-day discharge after G-tube placement are those already on home feeds who are just switching from one feeding route to another.
Another ideal group for same-day discharge are patients who only need a supplemental feed because you can feed them one time and then send them home.
When parents were given the choice of either staying overnight or going home after G-tube placement, most wanted to go home and less than 5% of families came back within 24 hours.
Nearly half of surgeons are already sending their gastrostomy patients home on the same day.