Early experience with single-incision laparoscopic surgery for the placement of a gastrostomy in a 10-year-old girl: a case report

Abstract

IntroductionAccess procedures for alimentation have been performed both endoscopically and surgically. In patients in whom endoscopic gastrostomy feeding tubes cannot be placed, single-incision laparoscopic surgery gastrostomy is an alternative method. This minimally invasive approach is a new technique performed through a single umbilical incision and without the need for additional laparoscopic ports.Case presentationIn this article we present a case of single-incision laparoscopic surgery gastrostomy performed with conventional laparoscopic instruments in a 10-year-old girl of Caucasian ethnicity who was not a candidate for a percutaneous endoscopic gastrostomy tube because of esophageal varices due to her advanced-stage cystic fibrosis with liver cirrhosis and portal hypertension. She also had an umbilical hernia, which was repaired during the same procedure through the same incision. Access and pneumoperitoneum were obtained through the umbilicus with the single-incision laparoscopic surgery port. The selected site for the feeding tube in the stomach was exteriorized through this incision and a feeding tube was placed. The stomach was returned into the abdomen. The fascial defect, and thus also the hernia, was repaired, and the 2cm umbilical incision was closed with endocutaneous sutures. The total operative time was 25 minutes. Our patient’s intra-operative and post-operative course was uneventful. We were able to use the feeding tube on the first post-operative day with good intestinal function. Our patient and her parents were pleased with the cosmetic result.ConclusionsThe single-incision laparoscopic surgery procedure seems to be a less invasive alternative to open placement of gastrostomy. This approach has the possible advantages of reduced post-operative pain, faster return to normal function, reduced port site complications, improved cosmesis and better patient satisfaction.

Laparoscopic surgery in patients with cystic fibrosis: A systematic review

“…Then the quality scores for the three quantitative and three qualitative articles with significant interrater correlation ( r s = 0.95, P = .02, two‐tailed) were compared based on four evidence grades, consistent with the GRADE protocol (Table 1). 19‐25 …”

“…Table 1 shows the other four articles—by Fathi et al, 20 Chen et al, 22 Abicht et al, 23 and Vanderlinden et al 24 — selected from our literature review. They were all assessed to be of moderate quality, meaning that their evidential value was low, and were therefore excluded from further analysis.…”

“…The chart method was used to confirm the accuracy of each article's title, abstract, introduction, rational for the report, research question(s), design, inclusion and exclusion criteria, subject selection method, subjects' missing status, where and when the study was performed, data collection, measurements and statistics, results, implications and limitations, conclusions, ethical considerations, and internal and external validity of the study. The quality ratings adhered to the following strict principles: high‐quality studies fulfilled 90% of 30 criteria 26‐28 moderate‐quality studies fulfilled 80% of 30 criteria, 23‐25 low‐quality studies fulfilled 70% of 30 criteria, 20‐22 and studies with insufficient quality fulfilled ≤69% of 30 criteria (ie, ≤20 criteria) (Table 1).…”