The gastrostomy “button”—A simple, skin-level, nonrefluxing device for long-term enteral feedings

doi:10.1016/S0022-3468(84)80373-5

Journal of Pediatric Surgery

Volume 19, Issue 6, December 1984, Pages 803-805

https://doi.org/10.1016/S0022-3468(84)80373-5 Get rights and content

In an effort to eliminate the common problems associated with gastrostomy tubes in children, we developed a silicone rubber gastrostomy “button” designed to replace the standard long latex tube. Easily inserted and self-retaining, the device remains practically flush with the skin. The intragastric portion is similar to a dePezzer catheter, and a one-way valve prevents reflux of gastric contents. Prototypes were evaluated in five children for a time period of 3 to 18 months. In two additional patients with esophageal stricture, the device was used as a temporary plug to maintain gastric stoma patency. Parents and nurses are pleased with the button's low profile, appearance, and ease to use. It is neither painful nor irritating, and there is no fear of dislodgement.

References (12)

CohenOM et al.
Skin level permanent feeding gastrostomy
Am J Surg
(1981)
GaudererMWL et al.
Gastrostomy without laparotomy: A percutaneous endoscopic technique
J Pediatr Surg
(1980)
HawsEB et al.
Complications of tube gastrostomy in infants and children. 15 year review of 240 cases
Ann Surg
(1966)
HolderTM et al.
Gastrostomy: Its use and dangers in pediatric patients
N Engl J Med
(1972)
GallagherMW et al.
Gastrostomy in padiatric patients: An analysis of complications and techniques
Surgery
(1973)
CampbellJR et al.
Gastrostomy in infants and children. An analysis of complications and techniques
Ann Surg
(1974)

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Cited by (83)

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Citation Excerpt :
Similarly, Mason et al evaluated techniques of securing the stomach to the anterior abdominal wall during laparoscopic GT placement and found improved outcomes with a temporary, external suture technique compared to use of a transfascial subcutaneous suture technique.5 The skin-level gastrostomy button emerged nearly 30 y ago with the purpose of preventing common problems and complications of GTs.25,26 These LPBs are preferred among some, given the lack of a long tube which can be bulky and uncomfortable for the patient, as well as more acceptable for families and caregivers.
This study evaluates tube-specific outcomes after primary placement of low-profile buttons (LPBs) compared with long gastrostomy tubes (LGTs).
All surgically placed gastrostomy tubes from 2015 to 2017 from a single institution were reviewed. Primary outcomes were tube dislodgement and tube-related readmissions within 30 d. Secondary outcomes were resource utilization and minor complications within 6 mo.
53% (n = 253) of patients received an LGT and 47% (n = 228) received an LPB. Groups were similar with regard to operative indication and approach, but LPB patients were slightly older (9 versus 6 mo, P = 0.02). Tube dislodgement occurred overall in 6% of patients, with 23% and 41% experiencing leakage and granulation tissue, respectively. LGT patients experienced higher rates of tube dislodgement (9% versus 3%, P = 0.006), but no difference in tube-related readmissions (P = 0.38). LGT patients were also more likely to visit the ER for a tube-related concern (43.9% versus 31.6%, P = 0.01) and report problems of leakage around the tube (27.7% versus 17.5%, P = 0.01). No difference was found for issues of peristomal granulation tissue or in tube-related readmissions.
Primary placement of low-profile gastrostomy buttons is safe and demonstrated superior tube-related outcomes compared with LGTs.
Gastrointestinal feeding access — From idea to application
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Button vesicostomy: 13 years of experience
2014, Journal of Pediatric Urology
Citation Excerpt :
In 2007, the button vesicostomy was described as a useful alternative short- or medium-term option for a catheterisable continent urinary stoma in children. The button vesicostomy uses a short, low-profile gastrostomy tube, originally designed for long-term enteral nutrition in patients with feeding difficulties [4], and provides a simple primary continent urinary stoma. This study aimed to review the indications for, and complications and outcomes from, using a button vesicostomy.
Over recent years the button vesicostomy has become an alternative management option in children with poor bladder emptying, when clean intermittent catheterisation (CIC) cannot be initiated for reasons of age, sensation, or urethral anatomy. This study reviews recent experience of this technique and evaluates its use.
Retrospective review of patients who had a button vesicostomy to permit bladder drainage between 1998 and 2011.
Thirty children underwent button vesicostomy insertion aged between 4 days and 16 years. Indications were neuropathic bladders (n = 15), congenital hypotonic bladders (n = 6), functional bladder disorders (n = 5), and post-obstruction bladders (n = 4). The median length of use was 11 months; however, 7 patients still have the button in situ. Minor complications (n = 12) included transient leakage, wound infection, and overgranulation. Major complications included 2 UTIs, 1 device failure, and 2 significant leaks, requiring revision of the tract and removal of the button.
The button vesicostomy is a suitable and safe technique for use in the short- and medium-term. The procedure has minimal morbidity and therefore is acceptable to families. It has a wide scope, including patients with a neuropathic bladder as an alternative to CIC and where temporary drainage is required until bladder function can recover.
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^*: Presented before the 15th Annual Meeting of the American Pediatric Association, Marco Beach, Florida, May 9–12, 1984.

¹: From the Division of Pediatric Surgery, The Department of Surgery, Rainbow Babies and Childrens Hospital of University Hospitals of Cleveland and the Department of Biomedical Engineering, Case Western Research University School of Medicine Cleveland, Ohio.

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The gastrostomy “button”—A simple, skin-level, nonrefluxing device for long-term enteral feedings*

Am J Surg

J Pediatr Surg

Complications of tube gastrostomy in infants and children. 15 year review of 240 cases

Ann Surg

Gastrostomy: Its use and dangers in pediatric patients

N Engl J Med

Gastrostomy in padiatric patients: An analysis of complications and techniques

Surgery

Gastrostomy in infants and children. An analysis of complications and techniques

Ann Surg