Synchronous laparoscopic-assisted percutaneous endoscopic gastrostomy and peritoneal dialysis catheter placement is a valid alternative to open surgery.
OBJECTIVE
Gastrostomy feeding is frequently necessary in children receiving chronic peritoneal dialysis (PD). Synchronous laparoscopic-assisted placement of percutaneous endoscopic gastrostomy (PEG) and PD catheter has many potential advantages. This study investigates whether this technique is comparable to open placement.


METHODS
The notes of all patients over a 16-year time period were reviewed retrospectively. Peritonitis was defined as the presence of a white blood cell count > 100/mm(3) with at least 50% being polymorphonuclear leukocytes, and infection was defined as the presence of positive peritoneal cultures with peritonitis.


RESULTS
Ten patients received primary laparoscopic-assisted PEG and PD catheter insertion (LAP) and 23 patients open gastrostomy and PD catheter (OPEN). PD catheter survival was median 12 months in the LAP group and 17 months in the OPEN group. Peritonitis and infection rates per catheter-year were 0.89 and 0.7 LAP and 0.59 and 0.5 OPEN. The risk of peritonitis and infection was not related to method of placement.


CONCLUSIONS
There were no statistically significant differences in outcomes between the two groups. We conclude that laparoscopic-assisted synchronous PD and PEG catheter insertion is safe and effective.
Department of Paediatric Surgery, Sheffield Children's NHS Trust, Western Bank, Sheffield S10 2TH, UK. richard.lindley@sch.nhs.uk
R M
RM
Lindley
A R
AR
Williams
N
N
Fraser
M U
MU
Shenoy
D000293:Adolescent; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D016896:Treatment Outcome