Endoscopic vs laparoscopic paediatric gastrostomies: Time to change our practice?

Koh, Claudia; Nicoara, Cezar Doru; Lansdale, Nick; Peters, Robert; Wilkinson, David

doi:10.1016/j.jpedsurg.2021.03.055

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…With the newer approach of MLG, the rate of postoperative complications has decreased, particularly leakage around the button and dislodgment of the button making this modified technique an enhanced surgical option for gastrostomy placement. This improvement in complication rate is consistent with the recent studies [ 5 , 12 ].…”

Section: Discussionsupporting

confidence: 93%

Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study

et al. 2022

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Background With gastrostomy becoming a common surgical procedure within the pediatric population surgeons continued to introduce modifications on the procedure to overcome some of the challenges and minimize complications. Modified U-stitches laparoscopic gastrostomy is gaining favor in some centers including the center of this study. Hence, this study was conducted to evaluate and compare its outcomes. Methods Eighty-nine gastrostomy procedures performed between 2013 and 2020 were reviewed to evaluate the surgical outcomes of a novel modified U-stitches laparoscopic gastrostomy (MLG) to the standard laparoscopic gastrostomy (LG) in children. The main outcome measured is the rate of postoperative complications encompassing dislodgement of gastrostomy button, leak around button, local infection, and development of granulation tissue post-surgery which is compared between the two population groups. Results The rate of leak around the button was found to be significantly less in the MLG (4%) compared to (15%) in the traditional LG approach with a p-value of 0.03. However, the overall complication rate for MGL is 63%; while it is 73% for LG. Conclusions The modified U-stitches laparoscopic gastrostomy has a lower rate of complications in comparison to the standard laparoscopic gastrostomy making it a preferred technique for gastrostomy placement in children.

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Section: Discussionsupporting

confidence: 93%

Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study

et al. 2022

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“…There were 16 (40%) females and 24 (60%) males. Median BM before PEG placement in females was 22 kg (IQR 15, 29) and for males 19 kg (IQR 11,34). Since there was no statistically significant difference between males and females in age, BM, BH and BMI at the time of PEG placement further analysis was conducted for all patients together (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…A minimally invasive laparoscopic approach has been well described as safe and effective method in many different conditions in children [28][29][30][31][32]. Several studies showed that percutaneous gastrostomy placement has more common major complications than the laparoscopic method [33,34]. Our study included patients with percutaneous gastrostomy placement, but we recorded only one major complication (gastrocolic fistula) which required resection of the part of colon together with the fistula.…”

Section: Discussionmentioning

confidence: 97%

Percutaneous Endoscopic Gastrostomy Tubes Can Be Considered Safe in Children: A Single-Center 11-Year Retrospective Analysis

et al. 2021

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Background and Objectives: When the human body is disabled to naturally ingest food through the mouth, enteral or parenteral nutritional support should be started. Percutaneous gastrostomy (PEG) is a flexible feeding tube that is inserted into the stomach through the abdominal wall in patients who will need long-term enteral nutrient intake. The aim of this study is to analyze clinical characteristic of children at the time of PEG placement as well as to determine indications, complications and outcomes associated with PEG at the Department of Pediatrics of the University Hospital of Split. Materials and Methods: Retrospective analysis of the medical records of patients treated from 2010 to 2020 was performed. The following data were collected from medical records: age, gender, information about nasogastric feeding before PEG placement, indication for PEG insertion, duration of PEG, procedure-related complications and treatment outcomes. Malnutrition was determined according to the z-score range for BMI for age and sex. According to the indication for PEG placement, patients were divided into five categories: central nervous system (CNS) diseases, neuromuscular diseases, genetic disorders, metabolic diseases, and group of children with polytrauma. Results: A total of 40 patients with median age of 110 months were included in study. At the time of PEG placement, most patients had deviations in body weight and height compared to expected values for age and sex. The most common underlying diagnoses were diseases of the central nervous system. Minor complications were found in 13 (35%) of patients. One patient (2.7%) developed major complication (gastrocolic fistula) and consequently underwent reoperation. The median duration of PEG in patients with complications before the need for replacement was 27 months, and in patients without complications, 43 months. Conclusions: Negative deviations of z-score body weight, body height, and body mass index could indicate the need for possible earlier placement of PEG. PEG can be considered as a safe therapeutic option in children since PEG-related complications, mostly in minor forms, were found in a small number of patients.

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“…Most recent comparison studies describe PEGs placed using the pull or push technique, leaving gastrostomy tubes with semi-rigid internal retention bumpers and no xation of the stomach to the abdominal wall. The aspects differ greatly from the laparoscopic technique and may account for the increased complications noted with PEGs in these studies [3,4,5,6,7,8,9,10,11,12,13]. At our institution, PEGs are placed via the introducer technique: gastrostomy tubes with internal retention balloons are inserted by way of Seldinger technique and stabilized with temporary xation of the stomach to the abdominal wall.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies comparing PEGs and LapGTs, there has been heterogeneity between the two techniques that makes comparison awed. For the most part, these investigations compare the pull or push technique of PEG insertion with LapGT [3,4,5,6,7,8,9,10]. This inconsistency is also seen in systematic reviews comparing PEGs and LapGTs [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy tube placement via the introducer technique is safe and effective in children when compared to the laparoscopic technique

et al. 2022

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We compare our experience of percutaneous endoscopic gastrostomy, introducer technique (PEG) and laparoscopic technique (LapGT) at a tertiary care pediatric hospital. MethodsIsolated PEGs and LapGTs placements were reviewed at our institution from August 2016 through January 2018. Demographics, procedure time, operative charges, and 30-day complications were reviewed. Means of quantitative values were compared using the student's t test. Categorical values were compared using the X 2 test. Results93 isolated gastrostomy tubes were placed in children aged 2 weeks to 19 years. There were 56 PEGs (60%) and 37 LapGTs (40%), based on surgeon preference. There was no signi cant difference in demographics between the two groups. Mean operative time for PEG was 59% shorter (14 vs. 33 minutes, p < 0.001). Operating room charges averaged $4,500 less in the PEG group ($11,400 vs. $15,900, p < 0.001). Neither group had complications that required a return to the operating room within 30 days postoperatively. There was no difference in the rate of fundoplication after gastrostomy tube placement. In two cases PEGs were converted to LapGTs after safety criteria for PEG were not met. ConclusionThe PEG introducer technique, when used with clearly de ned safety criteria, decreased operative time and cost without compromising safety.Level of evidence: level III HighlightsRetrospective comparison of percutaneous and laparoscopic gastrostomy, both using xation of the stomach to the abdominal wall, Seldinger technique and MIC gastrostomy tubes.Percutaneous gastrostomy has decreased cost, shorter operative times, and no difference in major complications.Percutaneous endoscopic gastrostomy is safe and effective in children compared to laparoscopic gastrostomy.

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Endoscopic vs laparoscopic paediatric gastrostomies: Time to change our practice?

Cited by 8 publications

References 13 publications

Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study

Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study

Percutaneous Endoscopic Gastrostomy Tubes Can Be Considered Safe in Children: A Single-Center 11-Year Retrospective Analysis

Percutaneous endoscopic gastrostomy tube placement via the introducer technique is safe and effective in children when compared to the laparoscopic technique

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