Background:
Pediatric gastric access for long term enteral feeding, may be performed via laparotomy, laparoscopy, or a percutaneous approach. The aim of this study was to report our experience with Laparoscopic Assisted Gastrostomy (LAG) in children and infants.
Methodology:
Prospective cohort study performed between March 2016 to March 2017 on 50 cases undergoing Laparoscopic Assisted Gastrostomy. Inclusion criteria included patients in need for long-term (>3 months) primary or supplemental enteral feeding e.g. post corrosive esophageal stricture, severe malnutrition. Exclusion criteria included those who are unfit for laparoscopic surgery and/or gastric anomalies.
Preoperative workup was done for all cases. Our Technique used three 5-mm ports to take three U-stitches to fix the anterior wall of the stomach to the anterior abdominal wall then the gastrostomy tube was inserted into the stomach. Patients were followed up postoperatively for 6 months for short and intermediate outcomes.
Results:
In 50 children, the procedure was successfully completed without conversion. The median patient age at the time of surgery was 3 years (0.5-14 years). The mean operative time was 30 minutes (25-45 minutes). Concurrent Laparoscopic Nissen fundoplication was performed (n = 8) the Laparoscopic Gastrostomy was placed after completion of Nissen fundoplication.
No intra-operative complication occurred; all tubes were successfully placed. Feeds were instituted the following day and advanced to goal. Minor postoperative complications included granulation tissue formation, stoma excoriation, tube dislodgement and leakage from around the stoma site. All postoperative complications were managed successfully with conservative measures. Revision Gastrostomy was not necessary.
Conclusion:
Based on our initial experience, Laparoscopic Assisted Gastrostomy is feasible, safe and effective minimally invasive procedure in children for feeding access. Based on our results it can also be widely used for patients as a first choice for Gastrostomy.
Keywords: Laparoscopy, Gastrostomy, Outcome
Background:
Pediatric gastric access for long term enteral feeding, may be performed via laparotomy, laparoscopy, or a percutaneous approach. The aim of this study was to report our experience with Laparoscopic Assisted Gastrostomy (LAG) in children and infants.
Methodology:
Prospective cohort study performed between March 2016 to March 2017 on 50 cases undergoing Laparoscopic Assisted Gastrostomy. Inclusion criteria included patients in need for long-term (>3 months) primary or supplemental enteral feeding e.g. post corrosive esophageal stricture, severe malnutrition. Exclusion criteria included those who are unfit for laparoscopic surgery and/or gastric anomalies.
Preoperative workup was done for all cases. Our Technique used three 5-mm ports to take three U-stitches to fix the anterior wall of the stomach to the anterior abdominal wall then the gastrostomy tube was inserted into the stomach. Patients were followed up postoperatively for 6 months for short and intermediate outcomes.
Results:
In 50 children, the procedure was successfully completed without conversion. The median patient age at the time of surgery was 3 years (0.5-14 years). The mean operative time was 30 minutes (25-45 minutes). Concurrent Laparoscopic Nissen fundoplication was performed (n = 8) the Laparoscopic Gastrostomy was placed after completion of Nissen fundoplication.
No intra-operative complication occurred; all tubes were successfully placed. Feeds were instituted the following day and advanced to goal. Minor postoperative complications included granulation tissue formation, stoma excoriation, tube dislodgement and leakage from around the stoma site. All postoperative complications were managed successfully with conservative measures. Revision Gastrostomy was not necessary.
Conclusion:
Based on our initial experience, Laparoscopic Assisted Gastrostomy is feasible, safe and effective minimally invasive procedure in children for feeding access. Based on our results it can also be widely used for patients as a first choice for Gastrostomy.
Anahtar Kelimeler: Laparoscopy, Gastrostomy, Outcome