title: Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy.
abstract: OBJECTIVE
  To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy (PEG) could be a valuable option for patients with complicated anatomy.
  
  
  METHODS
  A retrospective analysis of twelve patients (seven females, five males; six children, six young adults; mean age 19.2 years) with cerebral palsy, spastic quadriparesis, severe kyphoscoliosis and interposed organs and who required enteral nutrition (EN) due to starvation was performed. For all patients, standard PEG placement was impossible due to distorted anatomy. All the patients qualified for the laparoscopy-assisted PEG procedure.
  
  
  RESULTS
  In all twelve patients, the laparoscopy-assisted PEG was successful, and EN was introduced four to six hours after the PEG placement. There were no complications in the perioperative period, either technical or metabolic. All the patients were discharged from the hospital and were then effectively fed using bolus methods.
  
  
  CONCLUSIONS
  Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.
authors.affiliation: Adam Hermanowicz, Ewa Matuszczak, Marta Komarowska, Elzbieta Jarocka-Cyrta, Jerzy Wojnar, Wojciech Debek, Department of Pediatric Surgery, Medical University of Bialystok, 15-001 Bialystok, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Hermanowicz
authors.forename: Ewa
authors.initials: E
authors.lastname: Matuszczak
authors.forename: Marta
authors.initials: M
authors.lastname: Komarowska
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Jarocka-Cyrta
authors.forename: Jerzy
authors.initials: J
authors.lastname: Wojnar
authors.forename: Wojciech
authors.initials: W
authors.lastname: Debek
authors.forename: Konrad
authors.initials: K
authors.lastname: Matysiak
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Klek
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D013217:Starvation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Interposed organs; Laparoscopy-assisted percutaneous endoscopic gastrostomy; Malnutrition; Percutaneous endoscopic gastrostomy; Severe kyphosis