Laparoscopic or Endoscopic Gastrostomy in Children: Comparison of Two Methods

Abstract

Background and Purpose: Gastrostomy tubes are routinely placed endoscopically. However, complications are being reported with increasing frequency. To assess the relative efficacy of endoscopic and laparoscopic placement, we prospectively compared two groups of children in whom a gastrostomy tube was placed by either technique. Patients and Methods: Thirty-three gastrostomies were successively placed in 29 children. For patients with gastroesophageal reflux, an antireflux procedure was combined with a laparoscopic gastrostomy (lapG) placement (14 children). In the other cases, a percutaneous endoscopic gastrostomy (PEG) was performed (19 children). Results: The overall complication rate was 30% (37% for PEG and 21.5% for lapG). Major complications in the PEG group included fistula, irreducible restenosis, and peritonitis after button placement. Major complications in the lapG group consisted mainly of parietal infections. Conclusions: Gastrostomy tube placement is a serious operation that is associated with a high rate of complications whatever technique is used. Our series suggests that lapG is the best way to reduce morbidity. Better visualization makes it possible to choose the position of the gastrostomy in the stomach and abdominal wall accurately, avoid perforation of the colon or an intestinal loop, and fix the stomach to the rectal sheath securely. To decrease the incidence of parietal infections in lapG, we propose (1) the use of prophylactic antibiotics and (2) enlargement of the trocar opening. Primary button placement also decreases the rate of parietal complications.