Is endoscopy beneficial in pediatric laparoscopic gastrostomy insertion; A 9-year comparative study

Abstract

ObjectivesAdvancements in pediatric percutaneous endoscopic gastrostomy placement (PEG), laparoscopic-assisted gastrostomy (LAG) technique, and laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) procedure have opened up new options for gastrostomy tube placement. LAPEG utilizes endoscopy and laparoscopy for gastrostomy insertion. This review compares the outcomes and complications of LAG and LAPEG techniques in children.MethodsAll LAG and LAPEG gastrostomy tube placements in children from September 2010 to September 2019 were reviewed retrospectively. Patient demographic, along with procedural and 1-year complication data, were collected.ResultsIn total, 92/181 of gastrostomies were LAG and 89/181 were LAPEG. The mean age, weight and patient characteristics were comparable. Conversion rate was 1% in both groups (p = 0.74), there was no peritoneal leak in either group, a minor serosal injury to the stomach was seen in 1 patient in LAG with no bowel injury in LAPEG cohort (p = 0.51), need for re-operation was 1 and 2% in LAG and LAPEG, respectively (p = 0.49), early tube dislodgement was in 8 (9%) patients in LAG and 7 (6%) in LAPEG (p = 0.53) and wound infection was 13/92 in LAG and 11/89 in LAPEG (p = 0.8). The median operative time for LAPEG was less than LAG (p < 0.001) by 11 min but the median length of hospital stay was not significantly different (p < 0.096).ConclusionBoth LAG and LAPEG techniques in children are safe with comparable complication rates and length of hospital stay, the addition of endoscopy to LAG allowed for shorter operative time in the LAPEG technique.

Advances and challenges of gastrostomy insertion in children

“…In a retrospective review of 76 pediatric patients, LAPEG was performed and completed safely with no recognizable peri-operative complications, despite 26% of the cohort being considered high risk with significant pre-existing comorbidities. The safety and use of LAPEG has also been supported by previous reports[ 40 - 48 ]. A retrospective review comparing LAPEG to LAG demonstrated both procedures to be comparable in reducing the major complication rate but with the added advantage of significantly shorter procedure time in the LAPEG group[ 48 ].…”

“…The safety and use of LAPEG has also been supported by previous reports[ 40 - 48 ]. A retrospective review comparing LAPEG to LAG demonstrated both procedures to be comparable in reducing the major complication rate but with the added advantage of significantly shorter procedure time in the LAPEG group[ 48 ]. In the past, 10 kg of weight was considered the lower limit of body weight for insertion of PEG tubes, below which the procedure was deemed to be more technically challenging[ 49 ].…”

“…Using the laparoscope permits accuracy in the placement of the PEG, allows identification and subsequent lysis of adhesions, and safe completion of the PEG. In some centers LAPEG is performed routinely[ 31 ], in others it is used when PEG is felt to be unsafe or impossible, in other centers it is used if the abdominal wall is > 2 cm, making it technically difficult to perform a laparoscopic gastrostomy[ 32 ].…”