title: Laparoscopically supervised PEG at time of Nissen fundoplication: a safe option.
abstract: OBJECTIVE
  Children with gastroesophageal reflux disease (GERD) often have associated feeding difficulties that warrant the insertion of a feeding gastrostomy at the time of the antireflux procedure. Options for gastrostomy tube insertion at the time of laparoscopic Nissen fundoplication (LNF) include laparoscopic gastrostomy, percutaneous endoscopic gastrostomy (PEG), and classic open gastrostomy. The complication rate of PEG may be decreased if it is placed under laparoscopic supervision. The purpose of this paper is to describe our experience with laparoscopically supervised PEG tube placement at the time of antireflux procedure.
  
  
  METHODS
  A retrospective chart review was conducted on all children undergoing a PEG tube placement at the time of the LNF. Perioperative complications were recorded.
  
  
  RESULTS
  Forty-four patients had attempted PEG tube placement at the time of the LNF. In 3 (7%) cases, laparoscopic supervision was crucial in the prevention of a complication. No major PEG-related complications were recorded. In 43% of patients, minor PEG tube problems arose in the postoperative period: all were transient and/or easily correctable. Management of all these problems was in an outpatient setting. Follow-up ranged from 11 to 41 months.
  
  
  CONCLUSIONS
  PEG tube placement at the time of a LNF is safe and effective. A combined laparoscopic and endoscopic approach minimizes complications. This method also allows for an intra- and extraluminal evaluation of the fundoplication at its completion.
authors.affiliation: Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
authors.forename: Lena
authors.initials: L
authors.lastname: Perger
authors.forename: Libby
authors.initials: L
authors.lastname: Watch
authors.forename: Robert
authors.initials: R
authors.lastname: Weinsheimer
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fahl
authors.forename: Georges
authors.initials: G
authors.lastname: Azzie
mesh_terms: D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D012189:Retrospective Studies