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Literature review comparing laparoscopic and percutaneous endoscopic gastrostomies in a pediatric population
Madelen Lantz1, Helena Hultin Larsson, Einar Arnbjörnsson
1Department of Pediatric Surgery, Lund University Hospital, Sweden and Lund University Medical Center Skane (UMCS), 221 85 Lund, Sweden.
Insights
Laparoscopic gastrostomy in children significantly reduces serious gastrointestinal complications compared to percutaneous endoscopic gastrostomy (PEG). This surgical approach avoids blind punctures, enhancing patient safety and preventing emergency re-operations.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Gastrostomy is a common procedure for pediatric feeding access.
- Both laparoscopic and percutaneous endoscopic gastrostomy (PEG) are utilized.
- Complications, particularly gastrointestinal fistulas, are a concern.
Purpose of the Study:
- To compare the incidence of serious gastrointestinal complications between laparoscopic gastrostomy and PEG in children.
- To evaluate the safety and efficacy of each gastrostomy technique in a pediatric population.
Main Methods:
- Systematic review of publications from 1995-2009 on pediatric laparoscopic gastrostomy and PEG.
- Inclusion of prospective and retrospective studies.
- Calculation of inadvertent gastroenteric fistula frequency as a primary endpoint.
Main Results:
- Analysis of 54 studies involving 4331 children (1027 laparoscopic, 3304 PEG).
- Serious gastrointestinal fistulas occurred in 0% of laparoscopic cases versus 0.27% of PEG cases (P < .05).
- Laparoscopic gastrostomy demonstrated a significantly lower rate of severe complications.
Conclusions:
- Laparoscopic gastrostomy offers a safer alternative to PEG in children by avoiding blind abdominal punctures.
- This technique can prevent serious intestinal fistula complications associated with PEG.
- The findings support the use of laparoscopic gastrostomy for improved patient outcomes.
Abstract:
Objective. This study compares laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a paediatric population to test the hypothesis that there is a difference in the frequency of serious gastrointestinal complications between the two methods. Methods. All reports published between 1995 and 2009 on laparoscopic gastrostomy and PEG in children was included. Prospective and retrospective trials, comparing the two methods or dealing with one of them only were included. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Results. 822 publications were found when using the search terms: gastrostomy, gastrointestinal complications, and all child: 0-18 years. From these, 54 studies were extracted for this investigation. These studies reported a total of 4331 children undergoing gastrostomy operation, 1027 by using the laparoscopic technique and 3304 using the PEG technique. The number of serious gastrointestinal fistulas to colon or small bowel was 0% and .27%, respectively, P < .05. Conclusions. The results suggest that by performing laparoscopic gastrostomy in children it is possible to avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG.
