Laparoscopic gastrostomy in infants and children

Gastrostomy is a common procedure in children. Percutaneous endoscopic gastrostomy (PEG) is less traumatic than open surgery, but carries a higher risk in small children. We report our experience with laparoscopic gastrostomy, which appears to combine the advantages of the PEG and the safety of an open operation. Operative technique. An umbilical port (5 or 10 mm, depending on the patient's weight) and a left subcostal cannula (site of the future gastrostomy) are used. The stomach is pulled to the abdominal wall with two T-anchors, and the gastrostomy is performed using the Seldinger technique. A 17-Fr peel-away sheath is placed, through which a 5 mm endoscope is introduced to confirm its intragastric position. A 14-Fr balloon gastrostomy tube or button is then introduced. Results. Fifty-one children, aged 0 to 19 years (mean 4.4 +/- 6.4 years), underwent a total of 54 laparoscopic gastrostomies in a 42-month period. Thirty-three patients were younger than 2 years, and 22 weighed less than 5 kg. Thirty-three children had failure-to-thrive, 12 suffered from cerebral palsy and 8 from cystic fibrosis. Operative time was 33.6 +/- 14.3 minutes; in 18 cases, a concomitant Nissen fundoplication was performed (total operative time 76.5 +/- 58.7 minutes). In all cases, gastrostomy feedings were started the following day, and hospital stay in the gastrostomy-only group was 3.3 +/- 0.6 days. There were two (recognized) perforations of the back wall of the stomach, which were repaired laparoscopically, and two tube dislodgments, at 24 hours and at 4 months, requiring reoperation. Conclusions. Laparoscopy allows a quick and simple technique of gastrostomy placement under direct vision in even the smallest newborn and infant. It carries minimal operative risks and allows initiation of feedings within 24 hours.