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1
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Bitar R, Azaz A, Rawat D, Hobeldin M, Miqdady M, Abdelsalam S. Advances and challenges of gastrostomy insertion in children. World J Gastrointest Surg 2023; 15:1871-1878. [PMID: 37901743 PMCID: PMC10600771 DOI: 10.4240/wjgs.v15.i9.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 09/21/2023] Open
Abstract
When oral feeding cannot provide adequate nutritional support to children, enteral tube feeding becomes a necessity. The overall aim is to ultimately promote appropriate growth, improve the patient's quality of life and increase carer satisfaction. Nasogastric tube feeding is considered appropriate on a short-term basis. Alternatively, gastrostomy feeding offers a more convenient and safer feeding option especially as it does not require frequent replacements, and carries a lower risk of complications. Gastrostomy tube feeding should be considered when nasogastric tube feeding is required for more than 2-3 wk as per the ESPEN guidelines on artificial enteral nutrition. Several techniques can be used to insert gastrostomies in children including endoscopic, image guided and surgical gastrostomy insertion whether open or laparoscopic. Each technique has its own advantages and disadvantages. The timing of gastrostomy insertion, device choice and method of insertion is dependent on the local expertise, patient requirements and family preference, and should be individualized with a multidisciplinary team approach. We aim to review gastrostomy insertion in children including indications, contraindications, history of gastrostomy, insertion techniques and complications.
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Affiliation(s)
- Rana Bitar
- Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi 767451, United Arab Emirates
- Faculty of Medicine, Khalifa University, Abu Dhabi 767451, United Arab Emirates
| | - Amer Azaz
- Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi 767451, United Arab Emirates
- Faculty of Medicine, Khalifa University, Abu Dhabi 767451, United Arab Emirates
| | - David Rawat
- Pediatric Gastroenterology, Barts Health NHS Trust, London E1 1BB, United Kingdom
| | - Mohamed Hobeldin
- Pediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi 767451, United Arab Emirates
| | - Mohamad Miqdady
- Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi 767451, United Arab Emirates
- Faculty of Medicine, Khalifa University, Abu Dhabi 767451, United Arab Emirates
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Ohgaki Y, Ishibashi Y, Hatao F, Furuta R, Saito N, Inayoshi R, Morita Y. Laparoscopically assisted percutaneous endoscopic gastrostomy performed for remnant stomach in patient with amyotrophic lateral sclerosis: a case report. Surg Case Rep 2023; 9:98. [PMID: 37280445 DOI: 10.1186/s40792-023-01683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/04/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Although percutaneous endoscopic gastrostomy (PEG) offers better access to the gastrointestinal system, in patients with previous abdominal surgery, PEG can be unsuccessful. Laparoscopically assisted percutaneous endoscopic gastrostomy (LAPEG) is indicated for such patients. However, patients with amyotrophic lateral sclerosis (ALS) may be more susceptible to anesthesia-related complications than other patients, requiring the indications for LAPEG, along with perioperative management, to be considered carefully. CASE PRESENTATION A 70-year-old, male patient with ALS was referred to our hospital for a gastrostomy for progressive dysphagia. He had undergone an open distal gastrectomy for gastric ulcer perforation in his twenties. Upper gastrointestinal endoscopy denied the transillumination sign and focal finger invagination. Because the risk of respiratory complications caused by general anesthesia was not considered serious, the decision was made to perform a LAPEG. Under careful, intraoperative airway management and neuromuscular monitoring, adhesiolysis was performed to increase mobility of the remnant stomach. A gastrostomy tube was inserted through the abdominal wall and into the remnant stomach under laparoscopic and endoscopic guidance. The patient was discharged in stable condition on postoperative day 3 without any respiratory complications. CONCLUSIONS LAPEG was able to be performed in a patient with ALS with a previous gastrectomy. A perioperative team comprised of neurologists, endoscopists, surgeons, anesthesiologists, and nurses who are fully conversant with ALS must be assembled to deal with potentially complex medical issues related to the procedure and anesthetic and perioperative management.
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Affiliation(s)
- Yutaro Ohgaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Ryuichiro Furuta
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Noriyuki Saito
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Rie Inayoshi
- Department of Anesthesiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
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Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022; 14:286-303. [PMID: 35664365 PMCID: PMC9131834 DOI: 10.4240/wjgs.v14.i4.286] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 04/03/2022] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
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Affiliation(s)
- Anand Rajan
- Department ofGastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | | | - Jonathan Kessler
- Department ofInterventional Radiology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Trilokesh Dey Kidambi
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - James H Tabibian
- Department ofGastroenterology, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
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Prakash P, Su A, Mason L, Tabibian JH. Contrast-Enhanced, Fluoroscopically Guided Percutaneous Endoscopic Gastrostomy Tube Placement for the High-Risk Patient. ACG Case Rep J 2022; 9:e00740. [PMID: 38445070 PMCID: PMC10914230 DOI: 10.14309/crj.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/05/2021] [Indexed: 03/07/2024] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) tubes can facilitate enteric feeding in patients with severe malnutrition but may be technically challenging to place. We present a man with disseminated tuberculosis and severe cachexia refractory to oral intake and nasogastric tube placement. PEG placement was initially deemed high-risk, through endoscopic, interventional radiologic, or surgical approach, because of severe cachexia and dilated bowel loops interposed between the abdominal wall and stomach. We describe a novel, minimally invasive technique to enhance safety and feasibility of PEG placement, which led to significant improvement in nutritional status and facilitated successful response to tuberculosis therapy.
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Affiliation(s)
- Preeti Prakash
- Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Andrew Su
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Leona Mason
- Division of Infectious Diseases, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA
| | - James H. Tabibian
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA
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Zenitani M, Nose S, Sasaki T, Oue T. Safety and efficacy of laparoscopy-assisted percutaneous endoscopic gastrostomy in infants and small children weighing less than 10 kg: A comparison with larger patients. Asian J Endosc Surg 2021; 14:44-49. [PMID: 32319215 DOI: 10.1111/ases.12803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/18/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
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 CO2 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.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoko Nose
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Sasaki
- Division of Pediatric Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Lodin D, Gupta AK, Rubay D, Genuit T, Hus N. The Effectiveness of Laparoscopic-assisted Percutaneous Endoscopic Gastrostomy in Patients with Unfavorable Anatomy: A Single-center Retrospective Cohort Study. Cureus 2020; 12:e6647. [PMID: 31976184 PMCID: PMC6968833 DOI: 10.7759/cureus.6647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an easy means to provide enteral access in patients unable to maintain adequate nutrition via the oral route. In patients with morbid obesity, altered intra-abdominal anatomy due to prior abdominal surgery, the interposition of the colon or other factors precluding endoscopy, feeding tube placement by laparoscopic means (LAPEG) can provide a potentially safe alternative. The objective of this study was to examine the efficacy and outcomes of laparoscopic-assisted placement of PEG in adult patients. This is a retrospective cohort analysis of adult patients, who underwent PEG and/or laparoscopic-assisted percutaneous endoscopic gastrostomy placement (LAPEG) by two surgeons at a single institution. A total of 36 patients underwent PEG and/or LAPEG. No significant differences were found in the total and postoperative length of stay and mortality. There were no procedure-related complications in the LAPEG group versus two in the PEG group (8.7%), but this did not reach statistical significance. LAPEG was 100% successful in gaining enteral feeding access in patients that had failed PEG. The most common reason for PEG placement failure was colonic interposition (39%), followed by intra-abdominal adhesions and gastric displacement by hiatal hernia (each 23%). 38.5% of LAPG procedures could be done via 5-mm single port access, 38.5% required two-port and 23% required three-port access. In conclusion, LAPEG is a feasible minimally invasive alternative to gain enteral feeding access in patients that have failed PEG that does not increase the length of stay, morbidity or mortality.
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Affiliation(s)
- Daud Lodin
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Anupam K Gupta
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - David Rubay
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Thomas Genuit
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Nir Hus
- Surgery, Delray Medical Center, Delray Beach, USA
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Tanaka T, Ueda T, Yokoyama T, Sadamitsu T, Yoshimura A, Horiuchi H, Sawai M, Matsumoto M. Laparoscopic Percutaneous Endoscopic Gastrostomy Is Useful for Elderly. JSLS 2019; 23:JSLS.2019.00011. [PMID: 31148916 PMCID: PMC6535467 DOI: 10.4293/jsls.2019.00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: In recent years, enteral nutrition has become relatively easy to perform through the penetration of percutaneous endoscopic gastrostomy (PEG). However, there have been reports of complications, such as mispuncture of other organs at the time of performing PEG. Previously, we had constructed a gastrostomy under the laparotomy for difficult PEG cases, and 2 years ago, we introduced laparoscopically assisted PEG. This study aimed to clarify the feasibility and safety of LAPEG for elderly people over 65 years old. Methods: We evaluated the perioperative outcomes in 7 elderly patients who underwent LAPEG during these 2 years. In these subjects, the safety of LAPEG was evaluated retrospectively based on the surgical outcomes, perioperative complications, and postoperative course using the clinical archives. Results: The subjects' mean age was 81.1 ± 8.03 years. LAPEG was successful in all 7 patients. The median operation time was 38 minutes (range, 31–71 minutes). Intraoperative and postoperative early or late complications from LAPEG were not observed in our cases. Enteral nutrition was commenced 2 days after PEG placement in all cases without complications. Conclusion: We summarized the LAPEG cases performed at our institution for the elderly, and have reported its feasibility and safety. The strongest advantage of LAPEG was that it allowed placement of the PEG without any complication under direct observation of the intraperitoneal cavity to confirm the safety of each organ.
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Affiliation(s)
- Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Takeshi Ueda
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Takashi Yokoyama
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Tomomi Sadamitsu
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Hazuki Horiuchi
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
| | - Masayoshi Sawai
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
| | - Masami Matsumoto
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
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Sartori A, De Luca M, Lunardi C, Clemente N, Segato G, Rossi G, De Luca A, Minni M, Colaut F, Fortunato C, Nicolì F, Castiglioni C, Pellicanò N, Scaffidi G, De Marchi F. Laparoendoscopic Percutaneous Endoscopic Gastrostomy in Adults. J Laparoendosc Adv Surg Tech A 2018; 28:1192-1195. [DOI: 10.1089/lap.2018.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Maurizio De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Cesare Lunardi
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Nicola Clemente
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Gianni Segato
- Department of Surgery, Regional Hospital of Vicenza, Vicenza, Italy
| | - GianMaria Rossi
- Department of Surgery, Regional Hospital of Vicenza, Vicenza, Italy
| | - Alberto De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Massimo Minni
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Flavio Colaut
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Costanzo Fortunato
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Francesco Nicolì
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Cristina Castiglioni
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Natale Pellicanò
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Guido Scaffidi
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
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Kato K, Iwasaki Y, Onodera K, Matsuda M, Higuchi M, Kato K, Kato Y, Taniguchi M, Furukawa H. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Combined with CT-GC. J INVEST SURG 2017; 30:193-200. [PMID: 27700181 DOI: 10.1080/08941939.2016.1232451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. MATERIALS AND METHODS In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection. RESULTS In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients. CONCLUSIONS LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement.
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Affiliation(s)
- Kazuya Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yoshiaki Iwasaki
- b Department of Gastroenterology and Hepatology , Okayama University , Okayama , Japan
| | | | - Minoru Matsuda
- d Department of Surgery , Nihon University , Tokyo , Japan
| | - Mineko Higuchi
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Kimitaka Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yurina Kato
- e Department of Oral Surgery , Jikei University , Tokyo , Japan
| | - Masahiko Taniguchi
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
| | - Hiroyuki Furukawa
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
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Abstract
There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible. For these challenging situations, laparoscopic-assisted PEG (LAPEG) is an alternative option. LAPEG combines the advantages of PEG with direct intraperitoneal visualization, helping ensure a safe tube placement tract free of intervening organs or structures. In this review, we highlight some of the important factors of first-line gastrostomy techniques, with an emphasis on the utility and procedural technique of LAPEG when they are not feasible.
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Affiliation(s)
- Adarsh M Thaker
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA.
| | - Alireza Sedarat
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA
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Carpenter JL, Soeken TA, Correa AJ, Zamora IJ, Fallon SC, Kissler MJ, Fraser CD, Wesson DE. Feeding gastrostomy in children with complex heart disease: when is a fundoplication indicated? Pediatr Surg Int 2016; 32:285-9. [PMID: 26721475 DOI: 10.1007/s00383-015-3854-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Malnutrition is common among children with complex heart disease (CHD). Feeding gastrostomies are often used to improve the nutritional status of such patients. Our purpose was to evaluate a cohort of children with CHD following open Stamm gastrostomy without fundoplication. METHODS We reviewed all CHD patients who underwent feeding gastrostomy placement from 1/1/2004 to 4/7/2015. Demographic data, cardiac diagnoses, operative details, post-operative complications, and the need for GJ feeding and fundoplication were examined. RESULTS Open Stamm gastrostomy was performed in 111 patients. Median age at surgery was 37 weeks (3 weeks-13.7 years); average weight was 5.3 ± 4.9 kg. Thirty-four patients (30 %) experienced a total of 37 minor complications, including tube dislodgement after stoma maturation (20), superficial surgical site infection (13), mechanical failure (3), and bleeding (1). Three patients experienced a major complication (need for return to the OR or peri-operative death <30 days). Three patients required a subsequent fundoplication. Fifty-six surviving patients (62 %) continue gastrostomy feeds, of which 7 (13 %) patients require GJ feeds. CONCLUSION Children with CHD tolerate an open Stamm gastrostomy well with minimal major complications. These results support very selective use of fundoplication in infants and children with CHD who require a feeding gastrostomy.
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Affiliation(s)
- Jennifer L Carpenter
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA
| | - Timothy A Soeken
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA
| | - Alfred J Correa
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA
| | - Irving J Zamora
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA
| | - Sara C Fallon
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA
| | - Mark J Kissler
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr., Houston, TX, 77030, USA
| | - David E Wesson
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA.
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12
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Kato K, Taniguchi M, Iwasaki Y, Sasahara K, Nagase A, Onodera K, Matsuda M, Inaba Y, Kawakami T, Higuchi M, Kobashi Y, Furukawa H. Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography. Am J Surg 2015; 210:374-381. [PMID: 25912624 DOI: 10.1016/j.amjsurg.2014.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/04/2014] [Accepted: 10/11/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. METHODS In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. RESULTS A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. CONCLUSION CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.
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Affiliation(s)
- Kazuya Kato
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan.
| | - Masahiko Taniguchi
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Yoshiaki Iwasaki
- Department of Gastroenterology and Hepatology, Okayama University, 2-5-1, Shikata Town, Okayama City, Okayama 700-8558, Japan
| | - Keita Sasahara
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Atsushi Nagase
- Department of Surgery, Asahikawa Medical Center, 4048, 7 cyome, Hanasaki-cyo, Asahikawa City 070-8644, Japan
| | - Kazuhiko Onodera
- Department of Surgery, Hokuyu Hospital, 5-1, 6-6 Higashi-Sappro, Shiroishi-ku, Sapporo City 003-0006, Japan
| | - Minoru Matsuda
- Department of Surgery, Nihon University, 1-8-13 Surugadai Kanda, Chiyoda-ku, Tokyo 010-8309, Japan
| | - Yuhei Inaba
- Department of Internal Medicine, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
| | - Takako Kawakami
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Mineko Higuchi
- Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu, Town Kamikawa-gun, Hokkaido 078-0343, Japan
| | - Yuko Kobashi
- Department of Radiology, Jikei University, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Asahikawa Medical University, 1-1, 2-1, Midorigaoka, Asahikawa City 078-8510, Japan
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Abbassi Z, Naiken SP, Buchs NC, Staszewicz W, Giostra E, Morel P. Laparoscopic-assisted percutaneous endoscopic gastrostomy in two patients who failed percutaneous endoscopic gastrostomy. Int J Surg Case Rep 2015; 13:40-2. [PMID: 26101053 PMCID: PMC4529636 DOI: 10.1016/j.ijscr.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) is a common procedure to obtain a feeding tube. However, this technique might imply several difficulties and complications. The inability to transilluminate the abdominal wall may occur frequently, especially in obese or multi-operated patients. With the emergence of minimally invasive surgery, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) might provide a safe and efficient alternative. PRESENTATION OF CASES We report hereby two cases of patients having undergone LAPEG in our institution. Conventional PEGs were deemed impossible because of the absence of transillumination and motivated a surgical approach. Two obese patients with a Body Mass Index (BMI) of 31 and 45kg/m(2) respectively presented neurological condition (stroke and Parkinson's disease) requiring a feeding tube. While a PEG was unsuccessful (impossibility to transilluminate), a LAPEG was attempted. The procedure and the recovery were uneventful. DISCUSSION There are different techniques for gastrostomy tube placement: open gastrostomy, PEG and radiologic procedure. The PEG is associated with a significant risk of bowel perforation. LAPEG seems to be an interesting option in order to avoid an open gastrostomy in patients in whom a PEG cannot be performed. This is especially true in obese patients, where a transillumination cannot be performed. It offers an endoscopic view of the stomach simultaneously to the laparoscopic approach that allows a potential decrease of major complications. CONCLUSION While the literature reports mainly pediatric cases, we present herein two successful LAPEG in adult obese patients. In case of impossibility to perform PEG, this technique allows a safe direct visualization of the stomach and other adjacent organs.
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Affiliation(s)
- Ziad Abbassi
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland.
| | - Surennaidoo P Naiken
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Nicolas C Buchs
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Wojciech Staszewicz
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Emiliano Giostra
- Division of Gastroenterology, University Hospital of Geneva, Geneva, Switzerland
| | - Philippe Morel
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
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Gutwein LG, Helmig RD, Bahler CD, Ben-David K, Behrns KE. Design and experimental evaluation of an anti-leak feeding tube. J Surg Res 2015; 195:10-5. [PMID: 25687960 DOI: 10.1016/j.jss.2015.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/07/2015] [Accepted: 01/16/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Enteral feeding via gastrostomy or jejunostomy tube is often required to adequately treat patients with cancer, gastrointestinal disorders, and cerebral vascular accident. Although sufficient to provide adequate caloric intake, the present design of a gastrostomy tube is inadequate. Leakage of gastric contents onto the skin is commonplace prompting emergency department visits and skin damage that requires costly nonoperative and operative intervention. We introduce a new gastrostomy tube design and prototype that inhibits leakage by using an adjustable external retaining member, which compresses against the feeding tube shaft thereby preventing dynamic friction. METHODS A conventional external retaining member of a 22 French gastrostomy tube was tested against a novel compression-fitting external retaining member. Each gastrostomy tube was clamped to a scale and the external retaining member moved to slide along the tubing at a constant rate, and the applied frictional force was recorded. Thirty repetitions were performed. RESULTS The experimental prototype generated ×2.5-3 the frictional force preventing tube excursion. Mean (standard deviation) forces were 18 (3) versus 46 (4) ounces (n = 10, P = 2.57E-13) and 15 (4) versus 48 (4) ounces (n = 10, P = 1.90E-13) for conventional and experimental designs, respectively. Simulated in situ environment mean forces were 19 (3) versus 39 (3) ounces (n = 10, P = 3.30E-11) for conventional and experimental designs, respectively. CONCLUSIONS The experimental design created an increased static frictional force that inhibited the movement of the external retaining member against the gastrostomy tube. Clinical implementation is the next step to evaluate for reduced feeding tube morbidity and healthcare expenses by preventing leakage of gastric contents.
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Affiliation(s)
- Luke G Gutwein
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Clinton D Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kfir Ben-David
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Kevin E Behrns
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
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15
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Hermanowicz A, Matuszczak E, Komarowska M, Jarocka-Cyrta E, Wojnar J, Debek W, Matysiak K, Klek S. Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy. World J Gastroenterol 2013; 19:7696-7700. [PMID: 24282357 PMCID: PMC3837268 DOI: 10.3748/wjg.v19.i43.7696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/19/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy (PEG) could be a valuable option for patients with complicated anatomy.
METHODS: A retrospective analysis of twelve patients (seven females, five males; six children, six young adults; mean age 19.2 years) with cerebral palsy, spastic quadriparesis, severe kyphoscoliosis and interposed organs and who required enteral nutrition (EN) due to starvation was performed. For all patients, standard PEG placement was impossible due to distorted anatomy. All the patients qualified for the laparoscopy-assisted PEG procedure.
RESULTS: In all twelve patients, the laparoscopy-assisted PEG was successful, and EN was introduced four to six hours after the PEG placement. There were no complications in the perioperative period, either technical or metabolic. All the patients were discharged from the hospital and were then effectively fed using bolus methods.
CONCLUSION: Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely.
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16
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Shimizu Y, Okuyama H, Sasaki T, Nose S, Saka R. Laparoscopic-assisted percutaneous endoscopic gastrostomy: a simple and efficient technique for disabled elderly patients. JPEN J Parenter Enteral Nutr 2013; 38:475-80. [PMID: 23520134 DOI: 10.1177/0148607113481476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Percutaneous endoscopic gastrostomy (PEG) is a simplified catheter placement procedure for alimentation. Although the endoscopic approach to gastrostomy tube placement is a safe and well-tolerated procedure in most patients, the PEG procedure is difficult in elderly patients disabled since childhood who have severe scoliosis and malpositioning of the stomach. We describe a simple and effective laparoscopic-assisted PEG (LAPEG) technique that can be used for catheter placement in severely disabled patients. METHODS Thirteen severely disabled patients aged 14-57 years underwent gastrostomy tube placement with the LAPEG technique. After general anesthesia was achieved, an endoscope was placed into the stomach. Then, a 5-mm camera port was inserted at the umbilicus, and a 3-mm working port was inserted to identify and lift the optimal site for gastrostomy tube placement. After the 4-point fixation of the stomach, the 20-Fr gastrostomy tube was placed under endoscopic and laparoscopic observation. RESULTS All patients tolerated the procedure well, and there were no major complications. The procedure was successful, and all patients could feed via the tube. CONCLUSIONS Elderly disabled patients who have been bedridden since childhood often have severe scoliosis and malpositioning of the stomach. Our LAPEG procedure is effective, well tolerated, and safe for gastrostomy tube placement in such elderly patients.
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Affiliation(s)
- Yoshiyuki Shimizu
- Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan
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17
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Hassan SF, Pimpalwar AP. Modified laparoendoscopic gastrostomy tube (LEGT) placement. Pediatr Surg Int 2011; 27:1249-54. [PMID: 21947136 DOI: 10.1007/s00383-011-2977-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to report the outcomes of our modified LEGT technique. METHODS Charts of 26 children who underwent modified LEGT technique between May 2008 and February 2010 were retrospectively reviewed. Their age ranged from 7 days to 16 years. Under general anesthesia, a gastroscope was placed in the stomach and laparoscopic visualization was obtained through a 5 mm umbilical port. Using laparoscopic and gastroscopic visualization, four 2'0' PDS 'T'-Fasteners were placed around a proposed gastrostomy site in the stomach. These sutures were pulled externally and tied subcutaneously so that nothing was visible outside. The gastrostomy button was then placed in the center of these four sutures at the proposed gastrostomy button site. Once the gastrostomy balloon was inflated, the four sutures were pulled taut and tied subcutaneously to pexy the stomach to the abdominal wall. Visualization with the gastroscope and laparoscope ensured proper gastrostomy button placement. RESULTS At a median follow-up of 9 months (range 10 days-2 years), none of the patients had major complications and only five had minor gastrostomy site infection which completely resolved after antibiotic therapy. CONCLUSIONS LEGT is a safe and effective technique for placement of primary G buttons/tubes in children. The laparoscopic visualization of the LEGT avoids accidental gastro-enteric fistula formation and allows primary placement of the gastrostomy button without need for subsequent procedures. LEGT ensures that the G-button is placed within the gastric lumen. Additionally, the four 'T'-Fastener technique gives optimal fixation of the stomach to the abdominal wall, avoids accidental disruption of sutures as they are placed subcutaneously and has no need for suture removal at a post-operative visit as in other techniques. Since there are no other ports used except the umbilicus this technique provides excellent cosmetic results.
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Affiliation(s)
- Saif F Hassan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA
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18
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Joseph M, Meyers MO. Laparoscopic-Assisted Percutaneous Gastrostomy Tube Placement in the Initial Management of Resectable Esophageal and Gastroesophageal Junction Carcinoma. J Am Coll Surg 2010; 211:e21-4. [DOI: 10.1016/j.jamcollsurg.2010.06.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 06/22/2010] [Accepted: 06/28/2010] [Indexed: 01/24/2023]
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Burke DT, Geller AI. Peritonitis secondary to the migration of a trans-hepatically-placed percutaneous endoscopic gastrostomy tube: a case report. Arch Phys Med Rehabil 2009; 90:354-7. [PMID: 19236992 DOI: 10.1016/j.apmr.2008.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 06/04/2008] [Accepted: 06/08/2008] [Indexed: 12/31/2022]
Abstract
Enteral feeding by percutaneous endoscopic gastrostomy (PEG) tube has become a commonly used method of supplying nutrition to patients with impaired neurologic function. In this case study we describe a 33-year-old brain-injured patient whose PEG insertion was complicated by inadvertent malpositioning and subsequent infection. After initially being placed through the liver, the PEG tube migrated out several weeks later, resulting in intra-abdominal feed collection, peri-hepatic abscess formation, and peritonitis. Physicians should be aware of the potential for inadvertent positioning through other viscera, and consider optimal methods of intraprocedural monitoring and post placement verification.
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Affiliation(s)
- David T Burke
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA.
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20
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Smitherman S, Pimpalwar A. Laparoendoscopic Gastrostomy Tube Placement: Our All-in-One Technique. J Laparoendosc Adv Surg Tech A 2009; 19:119-23. [DOI: 10.1089/lap.2007.0210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sarah Smitherman
- University of Missouri–Columbia School of Medicine, Children's Hospital, University of Missouri Health Care, Columbia, Missouri
| | - Ashwin Pimpalwar
- Department of Pediatric Surgery, Children's Hospital, University of Missouri Health Care, Columbia, Missouri
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21
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Croshaw RL, Nottingham JM. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy: Its Role in Providing Enteric Access when Percutaneous Endoscopic Gastrostomy is not Possible. Am Surg 2006. [DOI: 10.1177/000313480607201215] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) replaced open surgical gastrostomy (OSG) as the preferred method for enteric access soon after its introduction in 1980.1 Since that time, laparoscopic gastrostomy (LG), percutaneous radiologic gastrostomy (PRG), and laparoscopic-assisted PEG (LAPEG) have been introduced. PEG and PRG have been found to be over 95 per cent successful, convenient, economical, and associated with less morbidity than OSG.2, 3 However, there are patients that are not appropriate candidates for, or have failed attempts at, PEG or PRG placement. At one time, OSG was the only option left for these patients, but they may be better served by LAPEG or, in some cases, LG. LAPEG offers less morbidity than OSG by having less pain and wound complications, and potentially may avoid the use of general anesthesia.4–6 We present a series of patients that underwent successful LAPEG placement after an unsuccessful attempt at PEG placement, and we describe its role in patient care.
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Abstract
Laparoscopic appendectomy (LA) is one of the common procedures being carried out in general surgery. The technique of bipolar coagulation (BC) has been effectively employed in obstetric and gynecologic procedures but has not been used for intestines. We present the technique of LA using BC at our center. The technique consisted of identifying the appendix and coagulating the appendicular stump with bipolar coagulation until there were no bubbles at the cautery site, and a constriction ring formed at the site of coagulation. Sixty patients with acute or recurrent appendicitis underwent the procedure. The median duration of BC was 90 seconds. The median duration of surgery was 25 minutes, postoperative hospital stay was 3 days, and time to oral feeds was 12 hours. The technique of laparoscopic appendectomy by bipolar coagulation is very simple and economical. The duration of surgery is less than for the standard technique of laparoscopic appendectomy; no clip applicators, needle holders or knot pushers are required, and no foreign materials like ligatures or clips are needed.
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23
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Guloglu R, Taviloglu K, Alimoglu O. Colon injury following percutaneous endoscopic gastrostomy tube insertion. J Laparoendosc Adv Surg Tech A 2003; 13:69-72. [PMID: 12676027 DOI: 10.1089/109264203321235520] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is used to provide a safe route for enteral feeding. However, serious complications may occur during the procedure, such as transverse colon injuries. It can be difficult to diagnose a colon injury after the procedure in a patient with cobormidities. Herein, we present a case of transverse colon injury following insertion of a PEG tube, discuss the possible complications of PEG, and review the recent literature. This case demonstrates the importance of careful PEG tube insertion and close follow-up of the patient's clinical status after a PEG procedure.
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Affiliation(s)
- Recep Guloglu
- Department of General Surgery, Istanbul Medical Faculty, University of Istanbul, Istanbul, Turkey.
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24
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25
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26
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Abstract
During a 30-month period, 28 children aged 6 months-15 years underwent fashioning of a laparoscopic gastrostomy. Indications for operation included: feeding difficulties and failure to thrive in neurologically impaired children (13); chronic renal failure (9); and others (6). There were 17 conventional tube and 11 button gastrostomies. Twelve children had insertion of a gastrostomy alone; the others underwent a concomitant laparoscopic Nissen fundoplication (NFP). The average operation time for gastrostomy alone was 65 min (range 35-104) and for gastrostomy plus NFP 155 min (range 130-246). There were no specific laparoscopic complications. Two patients who required large volumes of eternal drugs and peritoneal dialysis from the 1st post-operative day developed minor external leaks from their stomas. It appears that laparoscopy provides for safe and precise positioning of any standard balloon or button gastrostomy. It is a particularly attractive technique for use in patients already undergoing a laparoscopic fundoplication and those in whom other minimally invasive techniques are contraindicated or fail.
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Affiliation(s)
- G M Humphrey
- Department of Paediatric Surgery, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
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27
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28
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Reiertsen O, Larsen S, Trondsen E, Edwin B, Faerden AE, Rosseland AR. Randomized controlled trial with sequential design of laparoscopicversus conventional appendicectomy. Br J Surg 1997. [DOI: 10.1002/bjs.1800840632] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nazzal M, Ali MA, Turfah F, Kaidi A, Saba A, Pleatman M, Silva Y. Laparoscopic appendectomy: a viable alternative approach. J Laparoendosc Adv Surg Tech A 1997; 7:1-6. [PMID: 9453859 DOI: 10.1089/lap.1997.7.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic appendectomy (LA) is relatively a new technique and requires comparison to open appendectomy (OA) to determine the more favorable approach in the surgical management of acute appendicitis. We designed this study to compare the course and postoperative complications between LA and OA. We reviewed the charts of both groups of patients and followed their course in the hospital. Seventy-seven patients who underwent LA with one conversion to the open technique (1.3%) were compared to 84 patients who underwent OA. There was no difference in age and sex distribution. The mean hospital stay was shorter in the LA (32.5+/-10 vs 74.2+/-24 h, p < 0.0001). Parenteral analgesia requirement was higher in the OA group (4.7+/-1.4 vs 2.6+/-2, p < 0.0001). The total cost was higher in the OA group ($11,260+/-4000 vs 7,090+/-3500, p < 0.05). There was no significant difference in the OR time, duration of the procedure, and surgery costs between both groups. Normal appendices removed were similar in both OA and LA groups (23.8 vs 28.9%). There was no difference in the rates of postoperative complications between both groups. We conclude that LA is a viable alternative to OA. It is safe, cost effective, and less invasive than the OA with less pain and shorter hospital stay.
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Affiliation(s)
- M Nazzal
- Department of Surgery, North Oakland Medical Centers, Pontiac, Michigan 48341, USA
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30
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Richards K, Fisher K, Flores J, Christensen B. Surg Laparosc Endosc Percutan Tech 1996; 6:205-209. [DOI: 10.1097/00019509-199606000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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31
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Sayed Hassen AH, Cade RJ. A prospective trial of open versus laparoscopic appendicectomy. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:178-80. [PMID: 8639139 DOI: 10.1111/j.1445-2197.1996.tb01152.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND An assessment of the value of laparoscopic appendicectomy was performed. METHODS During 1993, all patients above the age of 13 years admitted with clinical appendicitis to Box Hill were assigned to an open or laparoscopic procedure depending on whether the surgeon on call was an 'open' or 'laparoscopic' surgeon for the purpose of the study. Ninety-two patients were entered in the study, of whom 57 were in the open group. The rate of histologically proven appendicitis was 73.9%. RESULTS No significant difference between the groups was found in the use of narcotic analgesia, length of stay or incidence of wound infection. However, operating time was significantly longer in the laparoscopic group. CONCLUSIONS Laparoscopic appendicectomy on an unselected group of patients does not confer many advantages but laparoscopy may be beneficial in certain subgroups.
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Affiliation(s)
- A H Sayed Hassen
- Department of General Surgery, Box Hill Hospital, Victoria, Australia
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Vogt W, Messmann H, Lock G, Gmeinwieser J, Feuerbach S, Schölmerich J, Holstege A. CT-guided PEG in patients with unsuccessful endoscopic transillumination. Gastrointest Endosc 1996; 43:138-40. [PMID: 8635708 DOI: 10.1016/s0016-5107(06)80116-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- W Vogt
- Department of Internal Medicine I, University of Regensburg, Germany
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Viani MP, Poggi RV, Pinto A, Fusai G, Andreani SM, Marvotti RA. Gasless laparoscopic gastrostomy. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1995; 5:245-9. [PMID: 7579678 DOI: 10.1089/lps.1995.5.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice in the nutritional management of patients requiring gastrostomies. Laparoscopic gastrostomy is usually performed when PEG is contraindicated, for example, in patients with esophageal strictures, large gastric tumors, or a history of multiple abdominal surgery. We report herein a case of gasless laparoscopic gastrostomy performed for carcinoma associated with a severe respiratory distress syndrome in a malnourished patient with a tight esophageal stricture. The gasless technique uses the Laparolift System (Laparolift, Origin Medsystem, Inc.), a device composed of a fan-shaped retractor and a mechanical lifting arm that produces an abdominal wall distention resembling a truncated pyramid. Gasless laparoscopy was a safe alternative approach to CO2 pneumoperitoneum in this patient.
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Affiliation(s)
- M P Viani
- Department of Surgery, Ospedale di Abbiategrasso, Milano, Italy
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Stylianos S, Flanigan LM. Laparoscopy-guided percutaneous button gastrostomy in children after previous abdominal surgery. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1995; 5:199-201. [PMID: 7548996 DOI: 10.1089/lps.1995.5.199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Children with previous abdominal surgery have not been optimal candidates for percutaneous endoscopic gastrostomy (PEG) insertion due to the possibility of inadvertant injury to adjacent structures. Using laparoscopic guidance we successfully inserted a primary PEG button in two children who had multiple previous abdominal procedures.
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Affiliation(s)
- S Stylianos
- Division of Pediatric Surgery, Babies and Children's Hospital of New York, Columbia University College of Physicians & Surgeons, New York, USA
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35
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Posta CG. Laparoscopic surgery in pregnancy: report on two cases. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1995; 5:203-5. [PMID: 7548997 DOI: 10.1089/lps.1995.5.203] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) are well-established surgical procedures. Although pregnancy initially was considered a contraindication to laparoscopic surgical procedures, successful reports of LC and LA during pregnancy have appeared in the surgical literature. Two cases are presented in this report, one LC and one LA, both in second-trimester pregnancies. Both pregnancies contained undisturbed and ended with spontaneous vaginal delivery of healthy infants. Laparoscopic surgery in pregnant patients is feasible and provides a reasonable alternative to the standard surgical approach.
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Affiliation(s)
- C G Posta
- General Surgery Service, United States Air Force Hospital, Hill Air Force Base, Utah, USA
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36
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Posta CG. Laparoscopic appendectomy: three-puncture technique with suspension of the appendix in nineteen cases. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1995; 5:77-80. [PMID: 7612946 DOI: 10.1089/lps.1995.5.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nineteen laparoscopic appendectomies by the same general surgeon are reported, using three trocar sites and suspending the appendix along the right lower quadrant trocar. This approach provides a fourth access site to the appendix without an additional port. Once the position of the appendix is stabilized, the two available ports are used to dissect around the base of the mesoappendix and place a silk ligature with extracorporeal ligating technique. All 19 procedures were completed by endoscopic means and without the use of endoscopic stapling devices, even when the mesoappendix was markedly swollen and edematous. The technique is presented here as an alterative method when performing laparoscopic appendectomy.
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Affiliation(s)
- C G Posta
- General Surgery Service, United States Air Force (USAF) Hospital, Hill Air Force Base (AFB), Utah, USA
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Stylianos S, Flanigan LM. Primary button gastrostomy: a simplified percutaneous, open, laparoscopy-guided technique. J Pediatr Surg 1995; 30:219-20. [PMID: 7738741 DOI: 10.1016/0022-3468(95)90563-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Button gastrostomy (BG) insertion has been a secondary procedure after initial open Stamm or percutaneous endoscopic tube gastrostomy. Previous attempts at primary open BG have been limited by the difficulty in bringing the BG "wings" through the abdominal wall. We employed an innovative technique for primary BG, which eliminates many of the disadvantages inherent in tube gastrostomy. METHODS From June 1993 to April 1994, primary BG insertion was performed in 34 children, using a silicon BG in a tapered peel-away sheath. Seventeen children had percutaneous endoscopic insertion of the BG. Six (35%) weighed less than 10 kg. Simultaneous laparoscopic guidance was used for percutaneous BG insertion in two children who had had multiple previous abdominal procedures. Open BG was performed during concomitant abdominal procedures in 15 patients and after unsuccessful percutaneous BG in two patients. Twelve patients (71%) weighed less than 10 kg. The standard Stamm technique was used for open BG insertion, and the tapered peel-away sheath was readily brought out through a remote incision in the abdominal wall. RESULTS The mean operative time for percutaneous primary BG was 12 minutes from needle insertion (range, 10 to 22 minutes). The mean time until BG feeding was 18 hours after insertion (range, 12 to 48 hours). No serious complications occurred in any of the 34 patients. Follow-up (1 to 10 months) has shown minor tissue reaction, minor leakage, and enthusiastic patient and parent satisfaction. CONCLUSION This innovative technique has proven safe and effective and allows for insertion of a skin-level, nonrefluxing, nonreactive, self-retaining feeding device, which eliminates the need for initial open or percutaneous tube gastrostomy and the associated complications. Potential cost savings may result through elimination of secondary button insertion procedures and the radiological studies often used to confirm proper button placement.
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Affiliation(s)
- S Stylianos
- Division of Pediatric Surgery, Babies and Children's Hospital of New York, Columbia University College of Physicians & Surgeons, NY 10032, USA
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