title: Modified laparoendoscopic gastrostomy tube (LEGT) placement.
abstract: OBJECTIVE
  The purpose of this study was to report the outcomes of our modified LEGT technique.
  
  
  METHODS
  Charts of 26 children who underwent modified LEGT technique between May 2008 and February 2010 were retrospectively reviewed. Their age ranged from 7 days to 16 years. Under general anesthesia, a gastroscope was placed in the stomach and laparoscopic visualization was obtained through a 5 mm umbilical port. Using laparoscopic and gastroscopic visualization, four 2'0' PDS 'T'-Fasteners were placed around a proposed gastrostomy site in the stomach. These sutures were pulled externally and tied subcutaneously so that nothing was visible outside. The gastrostomy button was then placed in the center of these four sutures at the proposed gastrostomy button site. Once the gastrostomy balloon was inflated, the four sutures were pulled taut and tied subcutaneously to pexy the stomach to the abdominal wall. Visualization with the gastroscope and laparoscope ensured proper gastrostomy button placement.
  
  
  RESULTS
  At a median follow-up of 9 months (range 10 days-2 years), none of the patients had major complications and only five had minor gastrostomy site infection which completely resolved after antibiotic therapy.
  
  
  CONCLUSIONS
  LEGT is a safe and effective technique for placement of primary G buttons/tubes in children. The laparoscopic visualization of the LEGT avoids accidental gastro-enteric fistula formation and allows primary placement of the gastrostomy button without need for subsequent procedures. LEGT ensures that the G-button is placed within the gastric lumen. Additionally, the four 'T'-Fastener technique gives optimal fixation of the stomach to the abdominal wall, avoids accidental disruption of sutures as they are placed subcutaneously and has no need for suture removal at a post-operative visit as in other techniques. Since there are no other ports used except the umbilicus this technique provides excellent cosmetic results.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
authors.forename: Saif F
authors.initials: SF
authors.lastname: Hassan
authors.forename: Ashwin P
authors.initials: AP
authors.lastname: Pimpalwar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000628:therapy*; D004750:Enteral Nutrition / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome