title: Gastrostomy tube placement in infants and children: is there a preferred technique?
abstract: OBJECTIVE
  Advances in percutaneous endoscopic gastrostomy (PEG) and laparoscopic (LAP) techniques, including LAP-assisted PEG, offer alternatives to the standard open gastrostomy technique. This study compares the outcomes of the PEG and LAP techniques.
  
  
  METHODS
  All gastrostomy tube placements were reviewed at our institution from January 2004 to October 2008. Demographic, procedural, and outcome data were collected. Univariate and logistic regression statistical analysis was performed with SPSS (SPSS, Chicago, IL), and P < or = .05 considered significant.
  
  
  RESULTS
  Of 238 gastrostomy tubes placed, 134 were PEG (56.3%) and 104 were LAP (43.7%). Most tubes were inserted for failure to thrive (74.4%) and feeding difficulties (52.1%). Patient weight and age were increased and operative time decreased for PEG compared with other methods. Percutaneous endoscopic gastrostomy patients also had a statistically higher number of postoperative complications, requiring a return trip to the operating room (P = .02).
  
  
  CONCLUSIONS
  Minimally invasive PEG and LAP techniques have supplanted the open technique for most patients. Operative time for PEG placement is shorter than other methods, and patients chosen for the PEG method of placement are older and of greater weight. However, there were significant and more serious postoperative complications requiring a second operation in the PEG group when compared with the LAP group.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA.
authors.forename: Begum
authors.initials: B
authors.lastname: Akay
authors.forename: Tony R
authors.initials: TR
authors.lastname: Capizzani
authors.forename: Alice M
authors.initials: AM
authors.lastname: Lee
authors.forename: Robert A
authors.initials: RA
authors.lastname: Drongowski
authors.forename: James D
authors.initials: JD
authors.lastname: Geiger
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
mesh_terms: D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004750:Enteral Nutrition / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome