Laparoscopic placement of a percutaneous endoscopic gastrostomy (PEG) feeding tube

Patients may have abnormal anatomic relationships between the stomach and adjacent organs, particularly when there is a history of abdominal surgery and adhesion formation. Routine placement of a percutaneous endoscopic gastrostomy tube can then be unsafe and result in inadvertent colon perforation, small bowel enterotomy, or injury to other structures. Described herein is a 94-year-old malnourished male in whom the colon lay directly anterior to the greater curvature of the stomach. A new technique was devised--laparoscopically-directed PEG placement--which proved to be a safer alternative approach in this patient.