Percutaneous endoscopic gastrostomy versus laparoscopic gastrostomy in pediatric age: A systematic review and...

Gastrostomy is essential for nutritional support in pediatric patients with severe neurological or chronic diseases. Percutaneous endoscopic gastrostomy (PEG) is widely used due to its rapid and minimally invasive nature. Laparoscopic techniques, such as laparoscopic gastrostomy (LAP) and laparoscopy-assisted gastrostomy (LA-PEG), offer alternative therapeutic options.

A systematic review and meta-analysis were conducted following PRISMA guidelines (PROSPERO CRD420251072017). Comparative studies published up to June 2025 were searched in PubMed, Embase, and CENTRAL. Pediatric patients (0-18 years) undergoing PEG, LAP, or LA-PEG were included; those with simultaneous procedures were excluded. Primary outcomes were major complications, mortality, surgical conversion, and reinterventions. Secondary outcomes included minor complications, operative time, hospital stay length, and time to start enteral nutrition. Study quality was evaluated using ROBINS-I and GRADE.

Nineteen studies with 6.642 patients (PEG = 3722, LAP = 2648, LA-PEG = 272) were included. No significant differences between PEG and LAP were found in surgical conversion, mortality, minor complications, length of hospital stay, or time to initiate nutrition. LAP showed significantly fewer major complications (p = 0.021) and reinterventions (p = 0.039) but longer operative time (p = 0.001). Similarly, LA-PEG had lower major complication rates (p = 0.001) and reinterventions (p = 0.029) than PEG, with increased operative time (p = 0.001). Mortality and minor complications did not differ significantly.

Laparoscopic techniques (LAP and LA-PEG) are safer than PEG concerning major complications and reinterventions, despite longer surgery times. PEG should be reserved for cases where laparoscopy is contraindicated.