Related Experiment Videos
Laparoscopic gastrostomy as an adjunctive procedure to laparoscopic fundoplication in children
L K Sampson1, K E Georgeson, D C Winters
1Department of Surgery, The Children's Hospital of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, Birmingham, Alabama 35233, USA.
Insights
Laparoscopic gastrostomy in children undergoing fundoplication is common. The U-stitch technique is preferred due to fewer complications compared to T-fastener and trocar-site methods.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastroesophageal reflux is common in infants and children, often requiring fundoplication.
- Many patients need concurrent gastrostomy placement due to associated medical conditions.
- Laparoscopic approaches are increasingly utilized for these combined procedures.
Purpose of the Study:
- To review the techniques, complications, and outcomes of laparoscopic Stamm gastrostomy.
- To compare different laparoscopic gastrostomy techniques performed with fundoplication.
- To identify the preferred technique for pediatric laparoscopic gastrostomy.
Main Methods:
- Review of 141 laparoscopic Stamm gastrostomies performed concurrently with laparoscopic fundoplication.
- Analysis of three techniques: T-fastener, trocar-site, and U-stitch.
- Documentation of complications and outcomes for each technique.
Main Results:
- The T-fastener technique was used in 63 cases, trocar-site in 53, and U-stitch in 26.
- Complications included gastrocutaneous fistulae (2/141), perigastrostomy cellulitis (8/141), and granulation tissue (45/141).
- The U-stitch technique was favored in this series.
Conclusions:
- Laparoscopic gastrostomy is a viable option for pediatric patients undergoing fundoplication.
- The U-stitch technique appears to be associated with a favorable complication profile.
- Careful technique selection is crucial to minimize morbidity.
Abstract:
Infants and children requiring fundoplication for gastroesophageal reflux frequently have significant associated medical problems necessitating placement of a gastrostomy at the time of fundoplication. This article reviews the techniques, complications, and results of 141 laparoscopic Stamm gastrostomies performed in conjunction with laparoscopic fundoplication in infants and children. The three techniques employed were the T-fastener technique (63/141) which is best utilized in patients with thick abdominal walls; the trocar-site technique (53/141) which is technically easy to perform but prone to infection and fistula formation; and the U-stitch technique (26/141). General complications of laparoscopic gastrostomy include development of gastrocutaneous fistulae (2/141), perigastrostomy cellulitis (8/141), and the formation of granulation tissue at the gastrostomy site (45/141). The only perioperative death was due to a technical error during gastrostomy tube placement. Our preferred method for laparoscopic gastrostomy in most children is the U-stitch technique.