title: Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard?
abstract: OBJECTIVE
  Gastrostomy tube insertion is frequently performed in children. Percutaneous endoscopic gastrostomy (PEG) insertion, considered by many to be the "gold standard," is unavoidably associated with a risk of intestinal perforation and frequently requires a second anesthetic for its replacement with a low-profile "button." We hypothesized that a laparoscopic technique with low-pressure insufflation would yield comparable outcomes, a lower procedural complication rate, and require fewer anesthetics per patient.
  
  
  METHODS
  A retrospective review of all surgeon-placed gastrostomy tubes (exclusive of those associated with fundoplication or other procedures) between January 2002 and December 2003 was undertaken. Data collected included type of procedure (PEG vs laparoscopic), indication, patient demographics (including neurologic comorbidity), operative time, complications (procedure-specific and nonspecific), and number of procedural anesthetics to "achieve" a low-profile tube. Groups were compared by univariate and multiple logistic regression analyses.
  
  
  RESULTS
  One hundred nineteen gastrostomy tubes (26 laparoscopic = 21.8%) were inserted. The PEG and laparoscopic gastrostomy groups were comparable from the perspectives of age, size, indications for tube placement, and operative time. The complication rate after PEG placement was significantly higher than after LG (14% vs 7.7%; P = .023), and 72 (77.4%) of PEG patients required a second anesthetic for tube change.
  
  
  CONCLUSIONS
  Laparoscopic gastrostomy tube insertion is safe and easy to perform, with outcomes comparable to that of PEG tube insertion. It obviates the need for a second procedural anesthetic and may emerge as the gold standard for gastrostomy tube placement.
authors.affiliation: Division of Pediatric Surgery, British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada V6H 3V4.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Zamakhshary
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jamal
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Blair
authors.forename: James J
authors.initials: JJ
authors.lastname: Murphy
authors.forename: Eric M
authors.initials: EM
authors.lastname: Webber
authors.forename: Erik D
authors.initials: ED
authors.lastname: Skarsgard
mesh_terms: D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D004867:Equipment Design; D005260:Female; D005773:Gastroscopy / Q000379:methods / Q000706:statistics & numerical data*; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D006801:Humans; D007416:Intestinal Perforation / Q000517:prevention & control; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D013536:Suture Techniques; D016896:Treatment Outcome