Gastrostomy tube placement in infants and children: is there a preferred technique?

Advances in percutaneous endoscopic gastrostomy (PEG) and laparoscopic (LAP) techniques, including LAP-assisted PEG, offer alternatives to the standard open gastrostomy technique. This study compares the outcomes of the PEG and LAP techniques. All gastrostomy tube placements were reviewed at our institution from January 2004 to October 2008. Demographic, procedural, and outcome data were collected. Univariate and logistic regression statistical analysis was performed with SPSS (SPSS, Chicago, IL), and P < or = .05 considered significant. Of 238 gastrostomy tubes placed, 134 were PEG (56.3%) and 104 were LAP (43.7%). Most tubes were inserted for failure to thrive (74.4%) and feeding difficulties (52.1%). Patient weight and age were increased and operative time decreased for PEG compared with other methods. Percutaneous endoscopic gastrostomy patients also had a statistically higher number of postoperative complications, requiring a return trip to the operating room (P = .02). Minimally invasive PEG and LAP techniques have supplanted the open technique for most patients. Operative time for PEG placement is shorter than other methods, and patients chosen for the PEG method of placement are older and of greater weight. However, there were significant and more serious postoperative complications requiring a second operation in the PEG group when compared with the LAP group.

Akay B ，Capizzani TR ，Lee AM ，Drongowski RA ，Geiger JD ，Hirschl RB ，Mychaliska GB ... -  《-》

Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard?

Zamakhshary M ，Jamal M ，Blair GK ，Murphy JJ ，Webber EM ，Skarsgard ED ... -  《-》

Alternative techniques of feeding gastrostomy in children: a critical analysis.

Goretsky MF ，Johnson N ，Farrell M ，Ziegler MM ... -  《JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS》

Gastrostomy insertion in children: percutaneous endoscopic or percutaneous image-guided?

Gastrostomy insertion in children can be performed in many ways, but which is the best technique remains uncertain. This study evaluates the outcome of percutaneous endoscopic gastrostomy (PEG) and image-guided gastrostomy (IG). We reviewed children who had either PEG (n = 136) inserted by pediatric surgeons or IG (n = 195) inserted by interventional radiologists in our hospital between May 2004 and July 2008. Gastrostomy-related complications were given scores ranging from 20 for major complications (eg, peritonitis, gastrointestinal bleed, and visceral injury) to 1 for minor (eg, site infection and tube migration), and total score per month of follow-up was calculated per patient. Conversion to laparoscopic or open gastrostomy was more frequent in PEG versus IG (P = .001). Fewer PEG patients (28%) had complications than did IG (47%) (P = .001). One PEG patient developed a gastrocolic fistula. In the IG group, 2 patients had transverse colon puncture, 1 had intraperitoneal tube detachment, and 1 had upper gastrointestinal bleeding. When scored and adjusted by length of follow-up, PEG had lower scores compared with IG, indicating a better outcome (P = .03). These findings were supported by zero-inflated Poisson regression analysis. Major complications were rare and observed more frequently after IG. Minor complications were observed in both procedures but were significantly less common in PEG.

Nah SA ，Narayanaswamy B ，Eaton S ，Coppi PD ，Kiely EM ，Curry JI ，Drake DP ，Barnacle AM ，Roebuck DJ ，Pierro A ... -  《-》

Gastroesophageal reflux disease in neurologically impaired children: the role of the gastrostomy tube.

We review our experience with gastrostomy techniques in neurologically impaired (NI) children, with or without a Nissen fundoplication. The records of 130 NI children who had a gastrostomy tube (GT) placed between January 1999 and October 2001 were reviewed. Data collected included: demographics, neurological status, operative time, time to first feed, postoperative stay, analgesic requirements, follow-up, mortality and complication rates. Open GTs were placed using the standard Stamm gastrostomy technique through a midline incision and were combined with a standard open Nissen fundoplication when indicated. Laparoscopic GTs were placed after institution of carbon dioxide pneumoperitoneum using a 2-port technique, a Mic-key G device of appropriate size and anchored to the anterior abdominal wall with 2 "U" stitches. The laparoscopic Nissen fundoplication (LNF) procedures were performed using a 5-port technique. Patients were divided into 4 groups: group I (n = 12) laparoscopic GT alone, group II (n = 44) open GT alone, Group III (n = 44) laparoscopic GT with LNF and Group IV (n = 30) open GT with Nissen fundoplication. Based on their similar characteristics, Groups I and II and Groups III and IV were compared together. Data were analysed using Student's t test, and internal review board approval was obtained. Patients ranged in age between 10 days and 17.7 years (mean 3.64 years). Their weight was between 1.2 and 63.4 kg (mean 12.8 kg). The compared groups showed similar characteristics with regard to age, weight, cause of mental impairment, and the reason for placement of the GT. The operative time for group III was significantly longer than that of group IV (P < 0.05). Time to first feed was significantly shorter for group I when compared to group II. The postoperative analgesic requirements were not statistically different. The overall short- and long-term complication rates were not statistically different when the related groups were compared, however, site-related complications and feeding problems were significantly less in group I compared to group II. Only 1 operative mortality occurred in group III. Follow-up showed less long-term morbidity and fewer complications with the laparoscopic GT compared to the open one as regard to admissions, surgery, and emergency department visits related to GT problems as well as frequency of GT change. Based on our experience, laparoscopic placement of a low-profile GT in NI children appears to be associated with less morbidity, permits earlier enteral nutrition, and has a cosmetic advantage. We believe that the laparoscopic technique should be the procedure of choice for GT placement in these children even when a Nissen fundoplication is deemed necessary.

Wadie GM ，Lobe TE 《-》