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Laparoscopic gastrostomy in children
1Department of Paediatric Surgery, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
Insights
Laparoscopic gastrostomy is a safe and effective procedure for children needing nutritional support or medication delivery. This minimally invasive technique offers precise placement and is ideal for patients undergoing other laparoscopic surgeries.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Procedures
- Gastroenterology
Background:
- Gastrostomy tubes are essential for nutritional support in children with feeding difficulties.
- Traditional open gastrostomy can be invasive.
- Laparoscopic techniques offer potential advantages in pediatric surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic gastrostomy in pediatric patients.
- To assess operative times and complications associated with the procedure.
- To determine the suitability of laparoscopy for gastrostomy placement in various pediatric conditions.
Main Methods:
- A retrospective review of 28 pediatric patients (6 months-15 years) undergoing laparoscopic gastrostomy over 30 months.
- Procedures included conventional tube and button gastrostomies, with some patients also receiving laparoscopic Nissen fundoplication.
- Data collected on indications, operative time, and complications.
Main Results:
- No specific laparoscopic complications were observed.
- Two patients experienced minor external stomal leaks.
- Average operative times were 65 minutes for gastrostomy alone and 155 minutes for gastrostomy plus Nissen fundoplication.
Conclusions:
- Laparoscopic gastrostomy is a safe and precise method for pediatric tube placement.
- It is particularly beneficial for children undergoing concomitant laparoscopic Nissen fundoplication.
- The technique is a viable alternative when other minimally invasive methods fail or are contraindicated.
Abstract:
During a 30-month period, 28 children aged 6 months-15 years underwent fashioning of a laparoscopic gastrostomy. Indications for operation included: feeding difficulties and failure to thrive in neurologically impaired children (13); chronic renal failure (9); and others (6). There were 17 conventional tube and 11 button gastrostomies. Twelve children had insertion of a gastrostomy alone; the others underwent a concomitant laparoscopic Nissen fundoplication (NFP). The average operation time for gastrostomy alone was 65 min (range 35-104) and for gastrostomy plus NFP 155 min (range 130-246). There were no specific laparoscopic complications. Two patients who required large volumes of eternal drugs and peritoneal dialysis from the 1st post-operative day developed minor external leaks from their stomas. It appears that laparoscopy provides for safe and precise positioning of any standard balloon or button gastrostomy. It is a particularly attractive technique for use in patients already undergoing a laparoscopic fundoplication and those in whom other minimally invasive techniques are contraindicated or fail.