title: Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents.
abstract: OBJECTIVE
  Pediatric gastric access for long-term enteral feeding may be performed via a laparotomy, laparoscopy, or a percutaneous approach. In children and adolescents, laparoscopic-assisted gastrostomy may be difficult due to a thick abdominal wall. Therefore, if the abdominal wall is estimated to be >2 cm on physical examination, or in children in whom a percutaneous endoscopic gastrostomy was unsuccessfully attempted by a gastroenterologist, we routinely perform a laparoscopic-assisted percutaneous endoscopic gastrostomy.
  
  
  METHODS
  From January 1998 through February 2003, we retrospectively reviewed 15 cases of a laparoscopic-assisted percutaneous endoscopic gastrostomy. Instruments used to perform this technique are a percutaneous endoscopic gastrostomy kit, an Olympus flexible endoscope, and one 5-mm STEP port placed through an infraumbilical incision for a 5-mm, 30-degree scope.
  
  
  RESULTS
  Age range was 2 years to 20 years (mean, 10). Operative time ranged from 20 minutes to 45 minutes. When a concurrent laparoscopic Nissen fundoplication was performed (n = 6), the percutaneous endoscopic gastrostomy was placed after completion of the Nissen fundoplication. No intraoperative complications occurred, and all tubes were successfully placed. Feeds were instituted the following day and advanced to goal. To date, no postoperative complications have occurred, and revision has not been necessary.
  
  
  CONCLUSIONS
  Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents is safe and effective. Utilizing laparoscopy permits evaluation of the peritoneum and lysis of adhesions, if necessary. Moreover, laparoscopy provides excellent exposure for accurate placement of the PEG, while avoiding injury to other organs.
authors.affiliation: Division of Pediatric Surgery, The Children's Hospital/The University of Colorado Health Science Center, Denver, Colorado 80218, USA.
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Yu
authors.forename: John K
authors.initials: JK
authors.lastname: Petty
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bruny
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hendrickson
mesh_terms: D000293:Adolescent; D002648:Child; D004750:Enteral Nutrition; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy; D012189:Retrospective Studies; D013997:Time Factors