title: Laparoscopic Gastrojejunostomy Tube Placement in Infants with Congenital Cardiac Disease.
abstract: BACKGROUND
  Gastrojejunostomy (GJ) tubes are an option for durable enteral access for critically ill infants with congenital cardiac disease who struggle with obtaining adequate nutrition.
  
  
  METHODS
  Infants weighing less than 10 kg with cardiac disease who received placement of a laparoscopic GJ tube from November 2011 to January 2015 were reviewed. The operative technique used an umbilical port for the camera and a single stab incision for the gastric access site. After insufflation to 5-8 mm Hg, the stomach was suspended to the abdominal wall, after which a dilator was maneuvered into a postpyloric position using laparoscopic visualization and fluoroscopy, and a glidewire was passed into the duodenum. The GJ tube was then fluoroscopically threaded over the glidewire; final position was confirmed by contrast injection.
  
  
  RESULTS
  There were 32 laparoscopic GJ tube placement operations performed; 7 (21.9%) of these tubes were standard single-unit GJ tubes, and 25 (78.1%) were low-profile gastrostomy tubes modified with a nasojejunal feeding tube threaded through the feeding port. Median patient age was 3.5 months (range, 0.75-11 months), with a median weight of 4.2 kg (range, 2.4-7.4 kg). Congenital defects were varied, including hypoplastic left heart syndrome and pulmonary vein stenosis. Median operative time was 62 minutes for isolated GJ placement (range, 35-114 minutes). There were three postoperative complications, resulting in a 30-day complication rate of 9.4%. Thirty-day mortality was 9.4% with no mortality related to the operation.
  
  
  CONCLUSIONS
  Laparoscopic GJ tube placement may be performed safely in infants with cardiac disease and allows these patients to receive adequate nutrition despite intolerance of gastric feeding.
authors.affiliation: 1 Department of Surgery, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Chinwendu
authors.initials: C
authors.lastname: Onwubiko
authors.affiliation: 1 Department of Surgery, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: 1 Department of Surgery, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Murphy
authors.affiliation: 2 Department of Gastroenterology, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Maireade E
authors.initials: ME
authors.lastname: McSweeney
authors.affiliation: 2 Department of Gastroenterology, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Julia
authors.initials: J
authors.lastname: Perkins
authors.affiliation: 3 Department of Cardiology, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Rahul H
authors.initials: RH
authors.lastname: Rathod
authors.affiliation: 4 Department of Cardiothoracic Surgery, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: Christopher
authors.initials: C
authors.lastname: Baird
authors.affiliation: 1 Department of Surgery, Boston Children's Hospital , Boston, Massachusetts.
authors.forename: C Jason
authors.initials: CJ
authors.lastname: Smithers
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D016896:Treatment Outcome