The purpose of this study was to review our experience with 83 operative gastrostomies (OG) and 51 percutaneous endoscopic gastrostomies (PEG) and assess the advantage of one procedure over the other. The overall complication rate for the OG group was 30% with three cases of gastrocutaneous fistula. The overall complication rate for the PEG group was 24%. The 30-day mortality for OG was 7% and for PEG, 10%. We conclude that both OG and PEG are effective methods of enteral access. No gastrocutaneous fistulas developed in patients who underwent PEG. In our experience, no statistically significant difference was noted in morbidity and mortality of either group.
Having the experience of more than 4,000 hypophysectomy operations (150 cases per year on the average) by the senior author, initially performed via an intracranial, then a transseptal approach, now a direct endonasal approach, as a minimal invasive technique, is introduced to reduce the complications and for better comfort of the patient. It is the least traumatic route to the sella turcica, it avoids brain retraction, and it provides excellent visualization of the pituitary gland and lesions related to that structure. The brilliant increased vision of the surgical target offered by the endoscope can enable a more effective removal of the lesion, followed by superior clinical results and a reduction in the incidence of complications.
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