Single-center experience of laparoscopically assisted percutaneous endoscopic gastrostomy placement.
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) is associated with major complications. Recently, laparoscopy has been used with or without endoscopy, in an attempt to reduce complications. The aim of this study was to evaluate a prospective audit of laparoscopically assisted PEG placement.


METHODS
A prospective study supported by a case note review of children undergoing laparoscopically assisted PEG placement, with and without Boix-Ochoa fundoplication, between July 2006 and July 2008, was carried out. Data were analyzed for predetermined parameters.


METHODS
Two 5-mm ports are utilized with the working port in the right-upper quadrant. The gastroscope is placed in the stomach. An atraumatic grasper is used to secure the stomach. The needle and sheath is passed through the anterior wall and into the stomach under direct vision, ensuring placement in the desired location. The gastrostomy-tube (GT) position is checked by the endoscopist and laparoscopist.


RESULTS
Twenty-nine children underwent a laparoscopically assisted PEG placement with (4 infants) and without (25 infants) laparoscopic fundoplication. There were 13 girls and 16 boys. The median age was 1 year and 8 months (range, 6 months to 16 years and 2 months). There were no complications related to laparoscopy. There were 3 superficial gastrostomy wound infections. Follow-up is 6 (range, 1-21) months.


CONCLUSIONS
Laparoscopically assisted PEG placement is a safe alternative to conventional methods. This technique provides direct visualization of the gastrostomy placement, avoiding other viscera, and allowing for the ideal siting of the GT.
Charlesworth
Paul
P
Department of Pediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom. paul.charlesworth@bsuh.nhs.uk
Hallows
Margret
M
van der Avoirt
Anouk
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005773:Gastroscopy / Q000379:methods; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies