Laparoscopic Gastrostomy Is Superior to Percutaneous Endoscopic Gastrostomy Tube Placement in Children Less Than 5 years of Age.
OBJECTIVE
Minimally invasive procedures for enteral access in children have evolved over the years, resulting in various techniques of gastrostomy tube placement. The two most common techniques are laparoscopic gastrostomy (LG) and percutaneous endoscopic gastrostomy (PEG). Our study compares the outcomes of both procedures exclusively in children under the age of five.


METHODS
All procedures relating to enteral access in children <5 years of age were reviewed retrospectively from July 2009 to July of 2014 as approved by our Institutional Review Board. Demographics, techniques, and complications were collected and analyzed.


RESULTS
Of 293 patients in our study, 150 patients underwent PEG, 75 LG, and 68 LG with Nissen fundoplication (LNG). The most common indication for enteral tube placement was failure to thrive and feeding intolerance. Operative time was less in the PEG group than in the other two groups (P = .001). Overall complication rate was 60% for LG and LNG and 58% for PEG (P = NS). The major complication rate was 3.3% in the PEG group and 0.7% for the LG and LNG groups. There were two deaths in the PEG group. Sixty-eight patients (45.3%) from the PEG group underwent tube changes under anesthesia, requiring additional trip to the operating room with general anesthesia compared with LG and LNG groups (2%) (P = .001). From the PEG group, 134 patients (89%) required many fluoroscopic interventions for tube dislodgments and conversion to gastrojejunostomy tubes for significant reflux and inability to use the gastrostomy (P = .001).


CONCLUSIONS
PEG tubes had a higher major complication rate than LG tubes with or without fundoplication in children <5 years of age. Despite longer operative time, LG seems to be the procedure of choice for children of this age for enteral access. Elimination of unnecessary tube changes under anesthesia and the fluoroscopic interventions after the PEG would be beneficial.
Department of General and Thoracic Surgery, Children's National Health System , Washington, District of Columbia.
Mikael
M
Petrosyan
Department of General and Thoracic Surgery, Children's National Health System , Washington, District of Columbia.
Adham M
AM
Khalafallah
Department of General and Thoracic Surgery, Children's National Health System , Washington, District of Columbia.
Ashanti L
AL
Franklin
Department of General and Thoracic Surgery, Children's National Health System , Washington, District of Columbia.
Tina
T
Doan
Department of General and Thoracic Surgery, Children's National Health System , Washington, District of Columbia.
Timothy D
TD
Kane
D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D004219:District of Columbia; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008499:Medical Records; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome