title: Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath.
abstract: BACKGROUND
  This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure.
  
  
  METHODS
  We identified infants, children and young adults who underwent laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a "push" technique with a tear-away sheath.
  
  
  RESULTS
  We included 92 patients in our study. Mean age was 3.7 years (range 3 wk-5 yr), and mean weight was 11.2 (range 2.8-54) kg. Median procedural time was 20 (range 12-76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures.
  
  
  CONCLUSIONS
  Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges.
authors.affiliation: From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.affiliation: From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pepe
authors.affiliation: From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jones
authors.affiliation: From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont.
authors.forename: Andreana
authors.initials: A
authors.lastname: Bütter
authors.affiliation: From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Merritt
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult