title: Guided Transabdominal U-Stitches Gastropexy: A Simplified Technique for Secure Laparoscopic Gastrostomy Tube Insertion.
abstract: Introduction:Insecure gastropexy, gastric mucosa overgrowth, granulation tissue formation, and a nonhealing gastrostomy are unwanted consequences encountered in the current minimally invasive gastrostomy tube (GT) placement techniques. Aiming to overcome these problems we have developed a simplified laparoscopic-assisted GT insertion (LAG) procedure using guided transabdominal U-stitches (GTU) gastropexy.Materials and Methods:We retrospectively reviewed all LAG cases performed in our institute using the GTU technique. In brief, a curved clamp is inserted intragastrically through the laparoscopic port and guides a needle across the abdominal and gastric walls to exit, then re-enter back, through the port in an out-in-out fashion creating multiple spaced transabdominal U-stitches that are tied over pledgets.Results:Between March 2008 and January 2015, 31 cases had LAG attempted using GTU. Two cases were converted to open procedures for non-LAG-related reasons. The median age of the remaining 29 cases was 37 (range, 0.3-154.9) months. Of those patients, 20 had fundoplication (LAG-Fundo), whereas the remaining 9 had LAG-only. The mean operative times for LAG-Fundo and LAG-only were 148 ± 57.5 minutes and 41 ± 12.4 minutes, respectively. During a median follow-up of 21 (range, 4-81) months we did not encounter any procedure-related mortality, intraabdominal leaks, or bowel injuries. One patient required redo gastropexy due to unplanned early U-stitch removal, and 7 cases had transient external GT leak, granuloma formation, and/or skin infection.Conclusions:GTU can achieve a simple and secure LAG, avoiding the catastrophic complications of intraabdominal leak without the need of special instruments or enlarging the port's wound. Using a smaller wound and intraabdominally placed mucosa helps in minimizing the risk of wound infection and external leak. Transient complications are expected during the earlier phase of the learning curve.
authors.affiliation: Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Ayman
authors.initials: A
authors.lastname: Al-Jazaeri
authors.affiliation: Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Mosaed
authors.initials: M
authors.lastname: Al-Dekhayel
authors.affiliation: Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Nasser
authors.initials: N
authors.lastname: Al-Saleh
authors.affiliation: Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Turki
authors.affiliation: Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Dhaheri
authors.affiliation: Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Saifullah
authors.initials: S
authors.lastname: Khan
mesh_terms: D002648:Child; D002675:Child, Preschool; D061887:Conversion to Open Surgery; D004750:Enteral Nutrition; D005260:Female; D018662:Fundoplication / Q000379:methods; D059485:Gastropexy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques