Laparoscopic-assisted Gastrostomy Research Articles

A Comparison Between the Complications of Laparoscopic and Open Gastrostomy Tube Insertions: A Single-Center Study From Riyadh, Saudi Arabia.

Background and objective Gastrostomy is a procedure that involves placing a feeding tubethrough the abdominal wall into the stomachto provide nutritional support. There are several modes of gastrostomy tube insertion including laparoscopic-assisted gastrostomy (LAG), percutaneous endoscopic gastrostomy (PEG), and open gastrostomy(OG) procedure, among others. Although it is a widely performed procedure, limited data is available regarding gastrostomy inSaudi Arabia, specifically among the pediatric population. This study aimed to shed more light on different aspects of surgical gastrostomy procedures among pediatric patients at the King Abdullah Specialist Children's Hospital (KASCH) in Riyadh, Saudi Arabia. The main objective of our study was to report the indications and complications of both LAG and OGinsertions in the pediatric population. Methods A retrospective cross-sectional study was conducted at KASCH to analyze the different parameters related to LAG and OG insertions, and to evaluate for any association between these modes of insertion and their complications. Pertinent data on children from birth to 14 years of age were collected through consecutive sampling using a chart review. A total of 107 pediatric patients who underwent the procedurefrom 2016 to 2020 were evaluated. Results Demographically, the majority (58%) of gastrostomies were performed in infants (less than a year old).Additionally, our study showed a significantly increased association between LAG andcomplications such as discharge, (27.12%), skin manifestations (27.12%), and bleeding (10.17%) when compared to OG. Conclusion Based on our findings, LAG showed less favorable outcomes in contrast to OG. Further studies should be conducted to validate our findings and ensure consistent results and outcomes among different methods of gastrostomy tube insertion.

Is endoscopy beneficial in pediatric laparoscopic gastrostomy insertion; A 9-year comparative study.

ObjectivesAdvancements in pediatric percutaneous endoscopic gastrostomy placement (PEG), laparoscopic-assisted gastrostomy (LAG) technique, and laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) procedure have opened up new options for gastrostomy tube placement. LAPEG utilizes endoscopy and laparoscopy for gastrostomy insertion. This review compares the outcomes and complications of LAG and LAPEG techniques in children.MethodsAll LAG and LAPEG gastrostomy tube placements in children from September 2010 to September 2019 were reviewed retrospectively. Patient demographic, along with procedural and 1-year complication data, were collected.ResultsIn total, 92/181 of gastrostomies were LAG and 89/181 were LAPEG. The mean age, weight and patient characteristics were comparable. Conversion rate was 1% in both groups (p = 0.74), there was no peritoneal leak in either group, a minor serosal injury to the stomach was seen in 1 patient in LAG with no bowel injury in LAPEG cohort (p = 0.51), need for re-operation was 1 and 2% in LAG and LAPEG, respectively (p = 0.49), early tube dislodgement was in 8 (9%) patients in LAG and 7 (6%) in LAPEG (p = 0.53) and wound infection was 13/92 in LAG and 11/89 in LAPEG (p = 0.8). The median operative time for LAPEG was less than LAG (p < 0.001) by 11 min but the median length of hospital stay was not significantly different (p < 0.096).ConclusionBoth LAG and LAPEG techniques in children are safe with comparable complication rates and length of hospital stay, the addition of endoscopy to LAG allowed for shorter operative time in the LAPEG technique.

Evaluating the use of laparoscopic-assisted gastrostomy tube feeding in children with epidermolysis bullosa: A single-center retrospective study

BackgroundNutritional management of children with epidermolysis bullosa (EB) presents multiple challenges including reduced oral intake compounded by mucosal fragility. Gastrostomy tube feeding is effective in improving nutritional status however there is limited data on the safety and tolerance of this technique in EB children. We aim to review the effectiveness and morbidity of our minimally invasive two-port laparoscopic-assisted gastrostomy (LAG) approach using Seldinger techniques with serial dilatations in children with EB. MethodsA retrospective, observational cohort study was conducted on all consecutive EB patients who underwent LAG tube insertion between 2009 and 2019. Patient demographics, admission details and 12-month clinical outcomes were reported. Results32 EB patients underwent LAG placement. Median age at insertion was 7.3 (IQR ± 6.3) years, with 8 (25.0%) and 3 (9.4%) of patients also undergoing oesophageal dilatation and fundoplication, respectively. Minor complications arose in 58.1% of patients including: peri-stomal overgranulation (25.8%), gastrostomy infection (22.6%), pain (22.6%), mild gastrostomy leakage (16.1%), blockage (9.7%) and device failure (3.2%). 2 patients (6.5%) developed major complications with extensive gastrostomy site leakage. Improvements in growth were reflected in mean height Z-scores (-1.99 to -1.71). Mean weight Z-scores improved in patients aged 0–10 years (-2.30 to -1.61) and mean BMI Z-scores increased in patients more than 10 years (-2.71 to -1.46). No cases of gastrostomy-related mortality were reported. ConclusionLAG is well-tolerated in EB patients with improvements in growth and minimal morbidity 12-months post-gastrostomy insertion. An extended follow-up period is required to ascertain the long-term implications of gastrostomy feeding.

A Retrospective Review of Primary Percutaneous Endoscopic Gastrostomy and Laparoscopic Gastrostomy Tube Placement.

The laparoscopic-assisted gastrostomy tube placement (LAP) has increasingly become the preferred method for placing gastrostomy tubes in infants and children. The goal of this retrospective review was to examine our institutional experiences with our transition from the percutaneous endoscopic gastrostomy (PEG) procedure to LAP technique. All patients undergoing primary PEG or LAP gastrostomy at Boston Children's Hospital between January 2010 and June 2015 were identified. The primary aim was to compare complication rates within the first 6 months after tube placement; differences in total hospital procedural costs, hospital resource utilization, and postoperative gastroesophageal reflux disease were examined. Nine hundred and eighty-seven patients (442 PEG and 545 LAP gastrostomy tubes) were included. No differences in total complications within 6 months were seen. Patients undergoing PEG placement had more gastrostomy-related complications (PEG 30 [6.7%] vs LAP 13 [2.4%], P = 0.0007) and cellulitis (PEG 23 [5.1%] vs LAP 2 [0.4%], P = 0.03) within the first week of placement. Patients undergoing LAP procedures had more granulation tissue episodes (PEG 19 [4.4%] vs LAP 107 [19.8%], P = 0.005). No differences in emergency room visits, hospital readmissions, or postoperative gastroesophageal reflux disease were seen, although transition to a gastrojejunal tube was higher in patients undergoing LAP procedure (PEG 20 patients [4.6%] vs LAP 51 patients [9.5%], P = 0.0008). Total complications were similar between patients undergoing PEG versus LAP gastrostomy tube placement. Patients with the PEG procedure had more complications within the first week of placement versus patients with the LAP procedure had more granulation skin complications.

469 Evaluating the Use of Laparoscopic-Assisted Gastrostomy Tube Insertion in Children with Epidermolysis Bullosa: A Retrospective Observational Study

Abstract Introduction Nutritional management of children with epidermolysis bullosa (EB) presents multiple challenges including reduced oral intake and mucosal fragility. Laparoscopic-assisted gastrostomy (LAG) tube feeding is effective in improving nutritional status. We aim to review the effectiveness and morbidity of our minimally invasive laparoscopic-assisted approach in EB patients. Method A retrospective, observational cohort study was conducted on all EB patients who underwent LAG tube insertion between 2009 and 2019. Patient demographics, admission details and 12-month clinical outcomes were reported. Results 31 EB patients underwent LAG placement. Median age at insertion was 7.2 (IQR ± 6.5) years, with 8 (25.8%) and 3 (9.7%) of patients requiring oesophageal dilatation and fundoplication, respectively. 71.4% patients experienced minor complications including: overgranulation (35.7%), gastrostomy infection (32.1%), pain (21.4%), mild gastrostomy leakage (17.9%), blockage (10.7%) and late displacement (3.6%). 6 patients (21.4%) developed major complications with extensive gastrostomy site leakage. Only one patient required laparoscopic refashioning for stoma prolapse six years post-insertion. No cases of gastrostomy-related mortality were recorded and an improvement in both mean weight and height Z-scores was observed. Conclusions LAG is well-tolerated in EB patients with improvements in growth and minimal morbidity 12-months post-gastrostomy insertion. An extended follow-up period is required to ascertain long-term impacts of gastrostomy feeding.

A simplified laparoscopic-assisted gastrostomy technique: a single center experience

BackgroundAlthough percutaneous endoscopic gastrostomy (PEG) is considered simple and effective, major complications have been reported because of the partly blind placement technique. Laparoscopic gastrostomy was described to overcome most of the problems and the contraindications of PEG. Various modifications have been reported to anchor the stomach to the abdominal wall.This study aims at highlighting a single center experience using a simplified technique for gastrostomy and evaluates its outcome.ResultsThe age of the patients ranged from 7 days to 3 years (mean 11.75 ± 12 months in group A and 16 ± 3 months in group B). The mean body weight at time of gastrostomy was 6.5 ± 4.6 kg in group A and 7.5 ± 2 in group B. The mean operative time was 24.8 ± 4 min in group A and 25 ± 1.6 in group B, ranging from 18 to 31 min. The incidence of gastrostomy-related complications was 20% (three cases) in group A versus 12.5% (one case) among patients included in group B. Yet, this difference was statistically insignificant (p = 0.651). No major complications were reported apart from persistent gastrocutaneous fistula in one out of eight cases followed after removal of the gastrostomy (12.5%). There is no significant difference in the outcome either in neonates or in patients less than 5 kg.ConclusionsThe described simple technique of laparoscopic-assisted gastrostomy is easy, effective, and with a very low incidence of complications. It is also equally safe in neonates and children less than 5 kg.

Laparoscopic-assisted Stamm-gastrostomy: technical modifications to ease suturing inside the minimal trocar site.

A retrospective chart review was conducted of cases involving patients who underwent laparoscopic-assisted gastrostomy, using a simple extracorporeal method inside the trocar site from April 1998 to March 2018. One hundred five gastrostomy tubes were placed in a laparoscopic-assisted operation. All but two of the cases involved patients with neurological impairment. The mean age was 12.5years; 28 cases were > 16years of age. Seventy-five cases underwent gastrostomy during laparoscopic fundoplication. All gastrostomy procedures were completed without intraoperative difficulties; however, 8 cases, which involved a thick abdominal wall, required extension of the trocar site. No cases required conversion to open gastrostomy. No major complications were observed. Two patients developed continuous peristomal cellulitis after surgery, due to the mismatch of the site position and an unsuitable button device size. We demonstrated that laparoscopic gastrostomy with fully extracorporeal suturing within the trocar site is feasible and beneficial, especially for the most neurologically impaired pediatric cases. Technical modification, changing the order of the process, and suturing technique in the minimal space, made it easier to perform the procedures inside the minimal trocar hole.

Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants.

Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1–24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4–30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes , but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.

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

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.

Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Sphincterotomy for Suspected Sphincter of Oddi Dysfunction (SOD) Post Roux-En-Y Gastric Bypass.

Sphincter of Oddi dysfunction (SOD) is thought to be a cause of chronic abdominal pain post Roux-en-Y gastric bypass, and current practice of performing endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy is not supported by evidence. In addition to the complexity and risks of the procedure in patients with Roux-en-Y anatomy, the outcomes are uncertain and debatable. We performed a retrospective review and analysis of post-gastric bypass patients who had undergone ERCP with sphincterotomy to determine the effectiveness in patients with suspected SOD. Over a period of 5years at the University of Minnesota, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had a previous Roux-en-Y gastric bypass and whom had a subsequent ERCP for suspected SOD. Patients were categorized by modified Milwaukee classification, and outcomes were evaluated by patients' self-reporting of symptoms at follow-up. We identified 50 patients who underwent laparoscopic-assisted gastrostomy for endoscopic retrograde cholangiopancreatography post Roux-en-Y gastric bypass over the study period. Within this group, 35 patients (70%) were suspected to have SOD. Nine patients (25.7%) were classified as type I, 19 patients (54.3%) type II, and seven patients (20%) type III. Thirty-four patients (97.1%) had biliary sphincterotomy, and 17 patients (48.6%) had both biliary and pancreatic sphincterotomy. Fourteen (40%) had repeated ERCP. At median follow-up of 11.5months, type I SOD had two responders (25%), type II had nine responders (52.9%), and type III had one responder (14.3%). A subgroup analysis did not show significant differences in improvement of symptoms between patients whom had single versus repeated ERCP or biliary sphincterotomy alone versus both biliary and pancreatic sphincterotomy. Three patients (9%) had post-ERCP pancreatitis. SOD in patients post Roux-en-Y gastric bypass is complex due to multiple confounding factors. Rome III and Milwaukee classification systems assist us in the diagnosis and treatment of sphincter dysfunction until we have a better way to predict treatment response post sphincterotomy. Current treatment is based on the type of disorder and anatomy of biliary ducts. Types I and II sphincter dysfunction particularly associated with dilated biliary duct on imaging have the best response to endoscopic sphincterotomy and therefore should be considered taking into account the risks and benefit. Repeated sphincterotomy and concurrent pancreatic sphincterotomy is generally not useful.

Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

BACKGROUND:Percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy (LAG) are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method.METHODS:This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications.RESULTS:Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047), early tube dislodgements (P = 0.02) and complications that require reintervention under general anaesthesia (P < 0.001). Minor complications were equally frequent after both procedures.CONCLUSIONS:Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.

Usefulness of laparoscopic-assisted gastrostomy using a low-profile gastrostomy button-type of feeding device for patients with severe mental and physical disabilities

Usefulness of laparoscopic-assisted gastrostomy using a low-profile gastrostomy button-type of feeding device for patients with severe mental and physical disabilities

Mo1208 Laparoscopic Gastrostomy Is Safer Than Percutaneous Endoscopic Gastrostomy in Children: Results of a Systematic Review and Meta-Analysis

Background: A gastrostomy is frequently performed in children who require long-term enteral feeding. Nowadays gastrostomy placement is a minimally invasive procedure via either percutaneous endoscopic gastrostomy (PEG) or laparoscopic assisted gastrostomy (LAG). Both procedures are widely used in pediatric patients. However, no consensus exists on which type of approach is best practice in these patients. Aim: The aim of this study was to determine if PEG or LAG is the most effective and safe procedure in pediatric patients requiring a gastrostomy Method: A systematic review and meta-analysis was performed according to the guidelines in the PRISMA-statement. PubMed, EMBASE, and the Cochrane Library were searched to identify eligible articles. Results were pooled in meta-analyses and expressed as risk ratios (RR). Results: Our extensive literature search provided 2,342 articles. After title, abstract and full-text screening five original studies comparing PEG to LAG placement in children were identified. All studies had retrospective study designs. The completion rate (PEG 98%; LAG 100%) and time to full-enteral feeds (PEG 0.7 and LAG 0.8 days) of both procedures were similar. No studies reported data comparing the efficacy of feeding via the gastrostomy or its effect on developing gastroesophageal reflux (GER). Major complications, such as intraperitoneal leakage (RR 0.28; p=0.36; after tube exchange RR 3.14; p=0.28) and persistence of the gastrocutaneous fistula after removal of the gastrostomy tube (RR 0.94; p =0.92 ) were as frequently encountered after both PEG and LAG. However, PEG was associated with significantly more adjacent bowel injury (RR=5.55; p= 0.05), early tube dislodgement (RR=7.44; p=0.02), and complications requiring reintervention under general anesthesia in the operating room (RR=2.79; p=0.0008). The risk of developing minor complications was similar after both PEG and LAG placement. Conclusion: This systematic review and meta-analysis demonstrates a lack in studies comparing the effect of PEG and LAG on the efficacy of feeding via the gastrostomy tube and postoperative GER. However, major complications such as adjacent bowel injury, early tube dislodgements and complications requiring reintervention under general anesthesia in the operating room were significantly less frequent after LAG. Therefore, we conclude that LAG is the safest approach and should be the first choice in children requiring gastrostomy placement.

Prospective determination of percutaneous endoscopic gastrostomy complication rates in children: Still a safe procedure

Percutaneous endoscopic gastrostomy (PEG) placement in children has come under scrutiny with reports of improved safety profiles using laparoscopic-assisted techniques. However, these reports are generally limited by their retrospective nature and the inclusion of historically determined PEG complication rates in children. Complication rates associated with PEG placement in children have not been prospectively studied, and a true modern understanding of the safety profile of PEG when performed in children is unknown. We prospectively followed children undergoing PEG to establish a clear and current understanding of the complication rates associated with this procedure. Consecutive PEG procedures performed between December 2009 and August 2010 at a single, tertiary-care pediatric hospital were enrolled for study. Patients were followed prospectively for 90 days with data regarding complications acquired via standardized interviews at 7, 30, and 90 days postoperatively. We enrolled 103 patients for study. Median age and weight at time of operation was 8 months (range, 2 weeks-21 years) and 6.9 kg (range, 2-42). Patients underwent primary placement of either a PEG button (n = 70) or PEG tube (n = 33). There were no intraoperative complications, with a 100% procedure completion rate. Six deaths occurred during this follow-up time period (mean of 37 days postoperatively) and were attributed to causes other than PEG placement. Four patients were lost to follow-up. One PEG tube was electively discontinued before the end of the follow-up period without complication. Of the remaining 92 patients with complete data, 13 complications were observed in 10 patients. Total complication rate was 14%. Rates of PEG complications observed in this prospective study are low and are generally minor. Observed rates of PEG-specific complications are lower than historic reports. The safety profile of PEG when performed in today's pediatric population remains comparable in safety to techniques such as laparoscopic-assisted gastrostomy.

Postoperative complications in children undergoing video-assisted gastrostomy tube placement correlated to their age and diagnosis

Gastrostomy tube placements in children are associated with frequent postoperative complications. Children with gastrostomy tubes are frequent visitors to the emergency department and outpatient clinic. The aim of this study was to determine the incidence of postoperative gastrostomy complications and disclose if these were correlated to the patients’ age and diagnosis. This is a prospective study of children who had undergone laparoscopic gastrostomy tube placement from June 2006 through March 2011. Patient demographics, comorbidities, and complications were collected. Data were analyzed by Fisher’s exact test. P<0.05 is considered significant. One hundred and sixty-two children were evaluated, with the majority of patients < 2 years of age (106/162). All the patients had undergone laparoscopic-assisted gastrostomy with double U-stitch technique. Granulation tissue, vomiting, infection, leakage were the most common postoperative complications. The majority of patients with these complications had full resolution by the sixth postoperative month. Tube dislodgement was a complication, occurring 16 times in 14 of the patients (10%) and resulting in 16 emergency department (ED) visits. Diagnoses were predictive of complications, and age and gender were not. Granulation tissue, vomiting, infection, leakage and tube dislodgement are complications after gastrostomy placement in children. The age of the child, was not predictive of complications but children with congenital cardiac malformation and malignant diseases had more frequent postoperative complications.

Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series

To determine whether laparoscopic-assisted gastrostomy (LAG) has superseded percutaneous endoscopic gastrostomy (PEG) based on the clinical outcomes. A retrospective study was undertaken for the period January 06-December 09. Demographic and clinical outcomes were recorded and the two groups were compared. 164 patients were studied (PEG, n = 107; LAG, n = 57). 93.5 % of PEG patients required two general anaesthetics compared with 8 % of LAG patients. Median time to using the gastrostomy was 24 (range 0-168) h in PEG and 0 (0-96) h in LAG patients (p < 0.001). Major complications occurred in 15/107 (14 %) of PEG and 2/57 (3.5 %) of LAG patients (p = 0.05). Re-operation rate following complications was 18/107 (16.8 %) for PEG and 3/57 (5.2 %) for LAG (p = 0.05). Minor complications arose in 41/107 (38 %) of PEG and 32/57 (56 %) of LAG (p = 0.05). Post-operative hospital stay was 2 (1-40) days for PEG and 2 (0-20) days for LAG (p = 0.01). The day-case rate was 0/107 for PEG and 5/57 (9 %) for LAG. There was no gastrostomy-related mortality in the series. LAG requires fewer anaesthetics, is associated with shorter time to feeding, shortened hospital stay and has a reduced risk of major complications. LAG is a very good alternative to the PEG in children.

Severe gastro-oesophageal reflux necessitating fundoplication after percutaneous endoscopic and open gastrostomy in children

The three major techniques for a gastrostomy in children are open gastrostomy (OG), percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy. Here, we have evaluated the outcome after OG and PEG in 69 children operated in Kuopio University Hospital. The medical records of 69 consecutive children who had either PEG (n = 56) or OG (n = 13) over an 18-year period (1990-2008) were reviewed. There was no difference between the PEG- and OG-groups in the patients' characteristics, indications for tube placement and hospital stay. The mean procedure time was 43 min shorter in the PEG-group (28 ± 38 min) than in the OG-group (71 ± 58 min) (P = 0.003). Four children (8%) in the PEG-group and one (8%) in the OG-group required later surgical interventions related to gastrostomy. Severe gastro-oesophageal reflux (GER) necessitating fundoplication was detected in 15 children (27%) in the PEG-group and in 7 children (54%) in the OG-group (P = 0.06). The results of this study indicated a higher incidence for severe GER leading to fundoplication in children with OG, while no difference with complications and clinical outcome between the two techniques, OG and PEG, were observed.

Zugänge zur enteralen Ernährung beim kritisch Kranken und Schwerverletzten: Wo stehen wir jetzt?

BACKGROUND: Nutritional support in critically ill and injured patients is crucial. It can be provided via parenteral or enteral access, each of which has advantages and disadvantages. In this article, we review enteral support, particularly gut access. METHODS: We conducted a literature review. RESULTS: A number of techniques enable access to the gastrointestinal tract in critically ill and injured patients. A temporary orogastric (OG), nasogastric (NG), or nasojejunal (NJ) feeding tube can be placed. But the prevalent technique is the more permanent percutaneous endoscopic gastrostomy (PEG), which has economic as well as safety benefits. Other techniques include open operative gastrostomy, laparoscopic or laparoscopic-assisted gastrostomy, and jejunostomy. CONCLUSIONS: Nutritional support should be provided enterally, via gut access whenever possible. The issue of pre- versus post-pyloric access remains controversial. PEG is safe and economical for long-term access.

Postoperative Complications in Children Undergoing Gastrostomy Tube Placement

Gastrostomy tube placement is associated with frequent postoperative complications. The aims of this study were to 1) determine the incidence of postoperative gastrostomy complications and 2) determine if patient demographics, comorbidities, or operative technique could predict these complications. A retrospective review was conducted on children who underwent gastrostomy tube placement from June 2006 through August 2009. Patient demographics, comorbidities, operative technique, health care visits, and complications were collected. Data were analyzed by chi-squared analysis (P < 0.05 significant). One hundred and fifty-nine patients were evaluated, with the majority of patients <5 years of age (129/159). Ninety-four patients underwent open gastrostomy, 31 laparoscopic gastrostomy, and 34 laparoscopic-assisted gastrostomy. Granulation tissue was the most common postoperative complication, occurring in 58% of patients (93/159). The majority of patients with granulation tissue had full resolution by the fourth postoperative month. Tube dislodgement was the second most common complication, occurring 69 times in 44 of the patients (28%) and resulting in 59 emergency department (ED) visits. Overall, gastrostomy complications resulted in 100 ED and 462 clinic visits. Ninety-three percent (93/100) of ED visits resulted in discharge home from the ED. Gender, age, insurance status, and operative technique were not predictive of complications. Granulation tissue and tube dislodgement are the most common complications after gastrostomy placement in children. Gender, age, insurance status, and operative technique were not predictive of complications. Emergency department utilization is high in children with gastrostomy tubes.

Gastrostomy complications in infants and children: a comparative study

Gastrostomy is a commonly undertaken procedure in children. Methods for gastrostomy insertion have evolved and laparoscopy is commonly used to aid its insertion. The aim of this study is to review the outcome and complications of laparoscopic-assisted gastrostomy insertion. A retrospective case note review of children undergoing gastrostomy insertion by a single surgeon from 1999 to 2007. 114 children underwent gastrostomy insertion, 68 males and 46 females, with a median age of 55 months (IQR 28-149 months). The majority were neurologically impaired. 98 underwent laparoscopic-assisted PEG (86%), 1 was converted to open procedure (0.9%) and 16 had standard PEG (14%). Median follow-up was 10.5 months with 90 children having their original gastrostomy changed to a button at a median interval of 7.4 months. Complications observed included new or deteriorating gastro-oesophageal reflux (GOR) (n = 16), infection (n = 9), granulation tissue (n = 11), tube dislodgement (n = 2) and intra-abdominal leakage of feed (n = 2). There were two gastrocolic fistulae which occurred in the standard PEG group. The inadvertent formation of a gastrocolic fistula was avoided with the use of laparoscopy to aid PEG insertion.