Safety and efficacy of laparoscopy‐assisted percutaneous endoscopic gastrostomy in infants and small children weighing less than 10 kg: A comparison with larger patients

Abstract

Introduction: Laparoscopy-assisted percutaneous endoscopic gastrostomy (LAPEG) can reduce the risk of percutaneous endoscopic gastrostomy-related complications, such as intra-abdominal organ injury, and determine the optimal position for placement of the gastrostomy tube. We first employed LAPEG 10 years ago but limited its application to elderly patients. Indications for LAPEG have now expanded to small children. This retrospective study aimed to determine the feasibility of LAPEG in children weighing <10 kg. Methods: Our LAPEG procedure for small children involves three essential techniques: gastric insufflation with CO 2 to prevent intestinal dilation, a T-fastener device to overcome the difficulties of gastropexy, and primary placement of a button gastrostomy to create less torque than tube gastrostomy at the insertion site and to prevent early tube dislodgement. The medical records of 48 patients with physical and mental disabilities who underwent LAPEG between 2010 and 2018 were evaluated. The outcomes of LAPEG in patients weighing <10 kg (group A, n=11) and ≥10 kg (group B, n=37) were compared. Results: The LAPEG procedure was completed in all cases without intraoperative complications or open conversion. The median bodyweight of group A was 6.3 kg (range, 3.6-8.2 kg). None of the patients in group A developed postoperative complications such as stomal infection or dislodgement. The operative time was significantly shorter in group A than in group B (P < .05). Conclusion: By improving surgical techniques for small children, our LAPEG procedure might be feasible and safe for treating children weighing <10 kg, including those weighing as little as 3.6 kg.

Nationwide Survey for Pediatric Gastrostomy Tube Placement in Korea

“…With the implementation of laparoscopy, the disadvantages of conventional open surgery have greatly improved. 5 To date, PEG methods using UGI endoscopes have been recommended as a better way to implement them without complications and are easier than other methods for pediatric gastrostomy tube placement. However, if PEG procedures are difficult due to structural problems of the stomach or if fundoplication is required due to gastroesophageal reflux disease (GERD), a surgical method is required.…”

Experience with a Hybrid Procedure Involving Laparoscopic Fundoplication with Percutaneous Endoscopic Gastrostomy in Chronically Ill Children

“…Gastrostomy techniques include conventional surgical gastrostomy, laparoscopic gastrostomy (LG), percutaneous endoscopic gastroscopy (PEG), and laparoscopic-assisted PEG [ 4 , 5 ]. Laparoscopic Nissen fundoplication (LNF) is currently the method of choice in children with medically intractable GER and has been performed in many centers.…”