Laparoendoscopic Gastrostomy Tube Placement: Our All-in-One Technique

Abstract

Gastrostomy tube placement may be performed in numerous ways: percutaneous endoscopic gastrostomy (PEG), laparoscopic PEG, and laparoscopic gastrostomy tube placement. In this paper, we propose a new technique of laparoendoscopic gastrostomy tube (LEGT) placement, using a three-suture technique to pexy the stomach to the abdominal wall. This paper outlines the LEGT technique and its benefits over previously reported techniques. Five children were included in this study during 2007. Their ages ranged from 15 months to 14 years. Under general anesthesia, a gastroscope was placed in the stomach and laparoscopic visualization was obtained through a 5-mm umbilical port. Two small incisions were made transabdominally for working instruments. Using laparoscopic visualization, three sutures were placed around a proposed gastrostomy site in the stomach. These sutures were pulled externally, using a GraNee needle (R-Med, Inc., Oregon, OH). Under visualization by a gastroscope, the gastrostomy button was placed in the center of these three sutures at the proposed gastrostomy tube site. Once the gastrostomy balloon was inflated, the three sutures were pulled taught and tied subcutaneously to pexy the stomach to the abdominal wall. Inspection with the gastroscope and laparoscope ensured proper gastrostomy tube placement. All patients had no complications intra- or postoperatively and at 2 months of follow-up. An optimal cosmetic result was obtained, and there was no need for suture removal or a second procedure. The laparoscopic visualization of the LEGT avoids accidental gastrocolic fistula formation and allows primary placement of the gastrostomy button without need for subsequent procedures. The endoscopic visualization, if the LEGT ensures the gastrostomy tube, is placed within the gastric lumen. Additionally, the three-suture technique gives an optimal fixation of the stomach to the abdominal wall, gives outstanding cosmetic results, avoids accidental disruption of sutures, and has no need for suture removal at a postoperative visit. LEGT thus serves as a one-stop shopping approach for gastrostomy in children.