Comparing Different Techniques in Children With or Without a Simultaneous Fundoplication: Does the Gastrostomy Technique Matter?

Safety of the One Step Percutaneous Endoscopic Gastrostomy (Push-PEG) Button in Pediatric Patients

“…Three patients in the Pull‐PEG group had repeated local infections, whereas only 1 patient in the Push‐PEG group had 2 separate infections. Results of a retrospective survey by Demirel et al and a prospective study by Jacob et al in pediatric patients found both higher (28), as well as lower (29) complication rates for Push‐PEG. Kvello et al observed 54 complications in 41 pediatric patients (47%) in the first 30 days after Push‐PEG placement with T‐fastener fixation.…”

“…It was hypothesized that Pull-PEG may be associated with more frequent procedure-related infections because intestinal bacteria can more easily contact the iatrogenic wound (9). This could cases because it may lead to a reduction in severe complications in complex patients (28).…”

“…Of these, 4 patients (5%) had subcutaneously migrated T-fasteners that were removed under GA ( 27 ). Jacob et al described the outcome of the Push-PEG technique in 183 children, stating that this technique was safe and had lower infection rates compared with placement using the pull-technique (Push-PEG group 10.6% vs Pull-PEG group 29.0%) ( 28 ).…”

Innovative Techniques Associated with Traditional Abdominal Surgery in Complex Pediatric Cases: A Tertiary Center Experience

“…Besides isolated diagnostic or therapeutic endoscopy, the association of this technique with laparoscopic surgery is gaining popularity in abdominal surgeries. In this regard, simultaneous Nissen laparoscopic fundoplication and percutaneous endoscopic gastrostomy (PEG) [5] is one of the main associations performed at our center, mainly in neurologically impaired children [6]. Nissen fundoplication is the most common surgical approach for gastro-esophageal reflux, consisting of a posterior 360 degrees fundoplication, and aiming to re-establish proper esophagogastric junction [7,8].…”

“…Over the last ten years, our center has adopted the mini-invasive technique as the preferred approach for neurologically-impaired children (after multidisciplinary discussion patients were elected for PEG, laparo-assisted gastrostomy or PEG-combined laparoscopic Nissen fundoplication). From 2008 to 2018, a total of 127 patients underwent a gastrostomy fashioning; 91% of them underwent a Gauderer-Ponsky pull-technique percutaneous endoscopic gastrostomy [11], while the remaining 9% underwent a laparoscopic-assisted PEG fashioning or a Stamm procedure (open gastrostomy) [5]. Gauderer-Ponsky gastrostomy is commonly used, as general anesthesia is not usually required, and because this approach is feasible even in patients with severe musculoskeletal deformities.…”