PT  - JOURNAL ARTICLE
AU  - Livingston, Michael H.
AU  - Pepe, Daniel
AU  - Jones, Sarah
AU  - Bütter, Andreana
AU  - Merritt, Neil H.
TI  - Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath
AID  - 10.1503/cjs.014814
DP  - 2015 Aug 01
TA  - Canadian Journal of Surgery
PG  - 264--268
VI  - 58
IP  - 4
4099  - http://canjsurg.ca/content/58/4/264.short
4100  - http://canjsurg.ca/content/58/4/264.full
SO  - CAN J SURG2015 Aug 01; 58
AB  - Background: This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure.Methods: We identified infants, children and young adults who underwent laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a “push” technique with a tear-away sheath.Results: We included 92 patients in our study. Mean age was 3.7 years (range 3 wk–5 yr), and mean weight was 11.2 (range 2.8–54) kg. Median procedural time was 20 (range 12–76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures.Conclusion: Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges.