title: Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series.
abstract: OBJECTIVE
  To determine whether laparoscopic-assisted gastrostomy (LAG) has superseded percutaneous endoscopic gastrostomy (PEG) based on the clinical outcomes.
  
  
  METHODS
  A retrospective study was undertaken for the period January 06-December 09. Demographic and clinical outcomes were recorded and the two groups were compared.
  
  
  RESULTS
  164 patients were studied (PEG, n = 107; LAG, n = 57). 93.5 % of PEG patients required two general anaesthetics compared with 8 % of LAG patients. Median time to using the gastrostomy was 24 (range 0-168) h in PEG and 0 (0-96) h in LAG patients (p < 0.001). Major complications occurred in 15/107 (14 %) of PEG and 2/57 (3.5 %) of LAG patients (p = 0.05). Re-operation rate following complications was 18/107 (16.8 %) for PEG and 3/57 (5.2 %) for LAG (p = 0.05). Minor complications arose in 41/107 (38 %) of PEG and 32/57 (56 %) of LAG (p = 0.05). Post-operative hospital stay was 2 (1-40) days for PEG and 2 (0-20) days for LAG (p = 0.01). The day-case rate was 0/107 for PEG and 5/57 (9 %) for LAG. There was no gastrostomy-related mortality in the series.
  
  
  CONCLUSIONS
  LAG requires fewer anaesthetics, is associated with shorter time to feeding, shortened hospital stay and has a reduced risk of major complications. LAG is a very good alternative to the PEG in children.
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK. r.wragg@doctors.org.uk
authors.forename: Ruth Clare
authors.initials: RC
authors.lastname: Wragg
authors.forename: Heidi
authors.initials: H
authors.lastname: Salminen
authors.forename: Max
authors.initials: M
authors.lastname: Pachl
authors.forename: Michael
authors.initials: M
authors.lastname: Singh
authors.forename: Anthony
authors.initials: A
authors.lastname: Lander
authors.forename: Ingo
authors.initials: I
authors.lastname: Jester
authors.forename: Dakshesh
authors.initials: D
authors.lastname: Parikh
authors.forename: Girish
authors.initials: G
authors.lastname: Jawaheer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D016896:Treatment Outcome