RT Journal Article
SR Electronic
T1 Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 264
OP 268
DO 10.1503/cjs.014814
VO 58
IS 4
A1 Livingston, Michael H.
A1 Pepe, Daniel
A1 Jones, Sarah
A1 Bütter, Andreana
A1 Merritt, Neil H.
YR 2015
UL http://canjsurg.ca/content/58/4/264.abstract
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.