Indications, early complications, and the associated factors following open surgical gastrostomy in patients admitted to Mulago National Referral Hospital

Abstract

Background: Feeding gastrostomy, whether performed surgically or via percutaneous endoscopic or radiological methods, is the preferred approach for long-term enteral feeding in patients who are unable to swallow but possess a normally functioning gastrointestinal tract. However, there is limited data regarding open surgical gastrostomy, particularly concerning the indications, early complications, and factors associated with these complications in Uganda. Objective: To evaluate the indications, early complications, and associated factors following open surgical gastrostomy at Mulago National Referral Hospital. Methods: A six-month prospective cohort study was conducted in multiple hospital wards, including Accident and Emergency, Ear, Nose, and Throat, Intensive Care Unit, Neurology, Neurosurgery, and cardiothoracic wards, as well as the Uganda Cancer Institute. A total of 142 adult patients (≥18 years) scheduled for feeding gastrostomy tubes were operated on. Data on socio-demographics, anthropometrics, surgical indications, and operative details were collected. Patients were reviewed preoperatively, intraoperatively, and postoperatively on days 1, 3, 5, 15, and 25–30 to document complications. Data were analyzed using Stata version 15.0. Results: Of the 142 participants, 130 were followed up (median age: 60 years, IQR: 50.5–64),72.3% were male. The mean weight was 50.7 kg (SD = 7.7), and 33.1% were underweight. Esophageal cancer (60%) was the most common indication for gastrostomy. Peristomal wound infection was the most frequent early complication, influenced by poor feeding tube handling, malnutrition, low immunity, and comorbidities. Regional anesthesia was used in 86.9% of cases. 6 died along the follow-up, and 6 were lost to follow-up. Conclusion: Stage IV esophageal cancer was the primary indication for open surgical gastrostomy. The main early complications, including peristomal infection and wound leakage, were associated with poor feeding tube handling and patient-related factors. Most complications appeared after day 15 postoperatively. Improving caregiver education on feeding tube care may help reduce complications.