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Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents

Sherman C Yu1, John K Petty, Denis D Bensard

  • 1Division of Pediatric Surgery, The Children's Hospital/The University of Colorado Health Science Center, Denver, Colorado 80218, USA.

JSLS : Journal of the Society of Laparoendoscopic Surgeons
|August 27, 2005
PubMed

Insights

Laparoscopic-assisted percutaneous endoscopic gastrostomy is a safe and effective method for pediatric gastric access, especially for children with thick abdominal walls. This technique ensures accurate tube placement and avoids organ injury, leading to successful long-term enteral feeding.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Minimally Invasive Procedures

Background:

  • Pediatric gastric access for long-term enteral feeding presents challenges, particularly in children with thick abdominal walls.
  • Traditional methods like laparotomy, laparoscopy, or percutaneous endoscopic gastrostomy have limitations.
  • Laparoscopic-assisted techniques are considered when percutaneous endoscopic gastrostomy is difficult or has failed.

Purpose of the Study:

  • To evaluate the safety and efficacy of laparoscopic-assisted percutaneous endoscopic gastrostomy in pediatric patients.
  • To assess the suitability of this combined approach for children with challenging anatomy or previous failed attempts.

Main Methods:

  • Retrospective review of 15 pediatric cases undergoing laparoscopic-assisted percutaneous endoscopic gastrostomy between January 1998 and February 2003.
  • Utilized a percutaneous endoscopic gastrostomy kit, an Olympus flexible endoscope, and a 5-mm STEP port for laparoscopic access.
  • Procedure involved placement of the gastrostomy after concurrent laparoscopic Nissen fundoplication in 6 cases.

Main Results:

  • The study included patients aged 2 to 20 years (mean 10 years).
  • Operative times ranged from 20 to 45 minutes with no intraoperative complications.
  • All gastrostomy tubes were successfully placed, feeds were initiated the next day, and no postoperative complications or revisions were reported.

Conclusions:

  • Laparoscopic-assisted percutaneous endoscopic gastrostomy is a safe and effective procedure for pediatric patients requiring long-term enteral feeding.
  • The laparoscopic component allows for peritoneal evaluation, adhesion lysis, and provides excellent exposure for precise gastrostomy tube placement.
  • This technique minimizes the risk of injury to adjacent organs, enhancing patient safety.
Abstract

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