Percutaneous Endoscopic Gastrostomy (PEG) vs. Lap-assistedgastrostomy (LAG) in children; which is better in pediatric age group?

Abstract

Aim To compare the operative and postoperative results in pediatric patients who required gastrostomy insertion via laparoscope versus endoscope. Materials and methods The study was plotted on 49 patients with feeding difficulty and no gastroesophageal reflux requiring gastrostomy during the period between January 2016 and January 2019. They were classified into two groups according to the type of gastrostomy insertion. The first group (25 patients) underwent percutaneous gastrostomy insertion via an endoscope (PEG) and the second group (24 patients) underwent laparoscopic-assisted gastrostomy (LAG) insertion. Data for comparison included the mean operative time and postoperative recovery and the presence of complications. Results Group 1 (PEG group) scored a mean operative time of 16±4.5 min, which was much shorter when compared with the mean operative time of group 2 (laparoscopic insertion) which scored 42±7 min. No intraoperative complications were recorded in the LAG group while in the PEG group we had one case of intestinal injury. Regarding the postoperative course, group 1 (PEG) showed better postoperative recovery with much less postoperative pain with no scars and feeding was initiated as early as the first day postoperatively and we had one case of stomach wall erosion due to tight compression of the PEG lock on the abdominal wall. Group 2 (laparoscope) showed less patient’s tolerability to early feeding when compared with group 1 with a slightly higher score on the pain scale, we had one case of internal hernia which required reexploration. Conclusion Minimal invasive techniques for gastrostomy insertion became the procedures of choice. Better results regarding postoperative recovery and operative time can be achieved when doing it using the PEG technique rather than the LAG technique. Safety is still questionable with PEG techniques and requires more skillful and trained practitioners to avoid complications.