title: Combined laparoscopic-endoscopic placement of primary gastrojejunal feeding tubes in children: a preliminary report.
abstract: BACKGROUND
  Placement of a primary gastrojejunal tube (GJT) can be technically challenging and often requires an open procedure to negotiate the tube past the duodenal sweep into the jejunum. The alternative approach is to first place a gastrostomy tube (GT), which is then changed to a GJT under endoscopic or fluoroscopic guidance after waiting 6-8 weeks to allow the stoma to mature. We report a case series of primary GJT placement using a combined laparoscopic-endoscopic approach.
  
  
  METHODS
  We retrospectively reviewed patients who underwent a combined laparoscopic-endoscopic primary GJT placement. Patients' demographics and relevant clinical information were analyzed.
  
  
  RESULTS
  Six patients (4 male, 2 female) were identified. The median age at the time of operation was 30.2 months (range, 28 days-10 years). Five GJTs were successfully placed laparoscopically/endoscopically, and one procedure was converted to open. The mean operative time was 84 minutes (range, 63-102 minutes). Postoperative abdominal radiography confirmed post-pyloric tube position in all patients. Feedings were initiated on the first postoperative day. One intraoperative complication required conversion to an open procedure. No patients developed postoperative complications.
  
  
  CONCLUSIONS
  Laparoscopic-endoscopic primary GJT placement is technically feasible and an excellent alternative in patients who require transpyloric feeding access.
authors: Children's Hospital Los Angeles, Los Angeles, California, USA.
authors: Shannon L
authors: SL
authors: Castle
authors: Allison L
authors: AL
authors: Speer
authors: Manuel B
authors: MB
authors: Torres
authors: Dean M
authors: DM
authors: Anselmo
authors: Nam X
authors: NX
authors: Nguyen
mesh_terms: D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D007583:Jejunum; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies