Laparoscopy-assisted percutaneous gastrostomy tube placement along with laparoscopic gastropexy

Percutaneous endoscopic gastrostomy (PEG) has gained wide acceptance for patients suffering malnutrition. However, the PEG technique is not always feasible in cases in which endoscopic passage is not possible due to an obstruction in the esophagus.

Under general anesthesia, a 2.0 nylon suture with a straight needle was inserted into the peritoneal cavity approximately 1 cm cranial to the planned gastrostomy. After this straight needle was held with the laparoscopic needle holder, the layers of the anterior gastric wall were sutured, and then the needle was put through the abdominal wall. The same procedures were performed at 2 cm on the caudal side of the first suture. A trocar with a peel-away sheath was used to penetrate the gastric wall. The peel-away sheath was removed and a balloon catheter was placed between the two gastropexy sutures.

This surgical procedure was performed in 6 cases. The mean operation time was 46.7 ± 10.0 min, the postoperative courses were uneventful, and feeding was started on postoperative day 1 in all cases.

This laparoscopic gastrostomy procedure should be especially useful in patients in whom endoscopic passage is not possible due to a neck or esophageal stenosis.