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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bitar R, Syed A, Azaz A, Rawat D, Hobeldin M, Miqdady M, Abdelsalam S. Is endoscopy beneficial in pediatric laparoscopic gastrostomy insertion; A 9-year comparative study. Front Pediatr 2022; 10:950867. [PMID: 36034566 PMCID: PMC9402975 DOI: 10.3389/fped.2022.950867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Advancements in pediatric percutaneous endoscopic gastrostomy placement (PEG), laparoscopic-assisted gastrostomy (LAG) technique, and laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) procedure have opened up new options for gastrostomy tube placement. LAPEG utilizes endoscopy and laparoscopy for gastrostomy insertion. This review compares the outcomes and complications of LAG and LAPEG techniques in children. Methods All LAG and LAPEG gastrostomy tube placements in children from September 2010 to September 2019 were reviewed retrospectively. Patient demographic, along with procedural and 1-year complication data, were collected. Results In total, 92/181 of gastrostomies were LAG and 89/181 were LAPEG. The mean age, weight and patient characteristics were comparable. Conversion rate was 1% in both groups (p = 0.74), there was no peritoneal leak in either group, a minor serosal injury to the stomach was seen in 1 patient in LAG with no bowel injury in LAPEG cohort (p = 0.51), need for re-operation was 1 and 2% in LAG and LAPEG, respectively (p = 0.49), early tube dislodgement was in 8 (9%) patients in LAG and 7 (6%) in LAPEG (p = 0.53) and wound infection was 13/92 in LAG and 11/89 in LAPEG (p = 0.8). The median operative time for LAPEG was less than LAG (p < 0.001) by 11 min but the median length of hospital stay was not significantly different (p < 0.096). Conclusion Both LAG and LAPEG techniques in children are safe with comparable complication rates and length of hospital stay, the addition of endoscopy to LAG allowed for shorter operative time in the LAPEG technique.
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Affiliation(s)
- Rana Bitar
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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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: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Background and Objectives: New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure. Methods: In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination. Results: Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day. Conclusions: LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt.
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Affiliation(s)
- Mihail-Gabriel Dimofte
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania
| | - Vlad Porumb
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania
| | - Simona Nicolescu
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania
| | - Irina Ristescu
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Anaesthesia and Intensive Care, Regional Institute of Oncology Iasi, Department of Anaesthesia and Intensive Care, Iasi, Romania
| | - Sorinel Lunca
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Department of Surgery, Regional Institute of Oncology Iasi, Second Department of Oncologic Surgery, Iasi, Romania
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Livingston MH, Pepe D, Jones S, Bütter A, Merritt NH. Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath. Can J Surg 2015. [PMID: 26204365 DOI: 10.1503/cjs.014814] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure. METHODS We identified infants, children and young adults who underwent laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a "push" technique with a tear-away sheath. RESULTS We included 92 patients in our study. Mean age was 3.7 years (range 3 wk-5 yr), and mean weight was 11.2 (range 2.8-54) kg. Median procedural time was 20 (range 12-76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures. CONCLUSION Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges.
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Affiliation(s)
- Michael H Livingston
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Daniel Pepe
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Sarah Jones
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Andreana Bütter
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
| | - Neil H Merritt
- From the Division of General Surgery, Schulich School of Medicine & Dentistry, Western University (Livingston, Pepe, Jones, Bütter, Merritt); and the Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University (Jones, Bütter, Merritt), London, Ont
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Mimatsu K, Oida T, Kida K, Fukino N, Kawasaki A, Kano H, Kuboi Y, Amano S. Simultaneous laparoscopic Nissen fundoplication and percutaneous endoscopic gastrostomy to treat an elderly patient with a large paraesophageal hernia: a case report. Asian J Endosc Surg 2014; 7:165-8. [PMID: 24754880 DOI: 10.1111/ases.12081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/25/2013] [Accepted: 11/17/2013] [Indexed: 12/25/2022]
Abstract
Laparoscopic Nissen fundoplication (LNF) and gastrostomy are often performed in children with gastroesophageal reflux disease. With a population that is increasingly aging, the number of elderly patients with paraesophageal hernia who have a nutritional disorder due to dysphagia has increased. In these patients with feeding difficulties, LNF and percutaneous endoscopic gastrostomy (PEG) are effective procedures for providing nutritional support. Here, we describe the case of an 82-year-old woman with paraesophageal hernia and certain comorbidities. She was receiving enteral feeding through a nasogastric tube, which was discontinued because aspiration pneumonia occurred. Therefore, LNF and crural repair without mesh placement were performed. The PEG tube was placed using the Ponsky pull technique under direct visualization with a laparoscope and gastroscope. The patient's nutritional status improved after she received enteral nutrition through the PEG tube. Thus, LNF and PEG may be useful techniques for nutritional support in elderly patients with a large paraesophageal hernia.
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Affiliation(s)
- Kenji Mimatsu
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan
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10
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Abstract
We aimed at assessing the effect of using a "Funada-kit II" device during laparoscopy-assisted percutaneous endoscopic gastrostomy (Lap-PEG), by reviewing 29 cases of Lap-PEG we performed from 2001 to 2011. We started using the "Funada-kit II" (CREATE MEDIC CO., Kanagawa, Japan) device with two parallel needles to puncture the stomach and assist suturing the anterior gastric wall to the anterior abdominal wall during Lap-PEG in 2011 (F-PEG). By introducing a loop through the lumen of one needle which allows placement of a suture introduced through the lumen of the other needle. Once repeated, the stomach can be pexied at two points, approximately 2 cm apart. We compared Lap-PEG (n = 23) with F-PEG (n = 6) where the mean ages and weights at surgery and sex ratios were similar. All cases were uneventful without intraoperative complications, although one postoperative wound infection occurred in a Lap-PEG case. There were no differences in the duration of analgesia, time taken to commence tube feeding, and return to full feeding. However, mean operating time was significantly shorter in F-PEG (28.1 min) versus Lap-PEG (46.1 min) p < 0.05. As per results F-PEG would appear to be as safe as Lap-PEG, but much quicker.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Wragg RC, Salminen H, Pachl M, Singh M, Lander A, Jester I, Parikh D, Jawaheer G. Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series. Pediatr Surg Int 2012; 28:443-8. [PMID: 22476714 DOI: 10.1007/s00383-012-3079-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine whether laparoscopic-assisted gastrostomy (LAG) has superseded percutaneous endoscopic gastrostomy (PEG) based on the clinical outcomes. METHODS A retrospective study was undertaken for the period January 06-December 09. Demographic and clinical outcomes were recorded and the two groups were compared. RESULTS 164 patients were studied (PEG, n = 107; LAG, n = 57). 93.5 % of PEG patients required two general anaesthetics compared with 8 % of LAG patients. Median time to using the gastrostomy was 24 (range 0-168) h in PEG and 0 (0-96) h in LAG patients (p < 0.001). Major complications occurred in 15/107 (14 %) of PEG and 2/57 (3.5 %) of LAG patients (p = 0.05). Re-operation rate following complications was 18/107 (16.8 %) for PEG and 3/57 (5.2 %) for LAG (p = 0.05). Minor complications arose in 41/107 (38 %) of PEG and 32/57 (56 %) of LAG (p = 0.05). Post-operative hospital stay was 2 (1-40) days for PEG and 2 (0-20) days for LAG (p = 0.01). The day-case rate was 0/107 for PEG and 5/57 (9 %) for LAG. There was no gastrostomy-related mortality in the series. CONCLUSION LAG requires fewer anaesthetics, is associated with shorter time to feeding, shortened hospital stay and has a reduced risk of major complications. LAG is a very good alternative to the PEG in children.
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Kwon RS, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, Mamula P, Pedrosa MC, Rodriguez SA, Varadarajulu S, Song LMWK, Tierney WM. Enteral nutrition access devices. Gastrointest Endosc 2010; 72:236-48. [PMID: 20541746 DOI: 10.1016/j.gie.2010.02.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 02/03/2010] [Indexed: 12/12/2022]
Abstract
The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such situations, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the ASGE Governing Board. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2009 for articles related to endoscopy in patients requiring enteral feeding access by using the keywords "endoscopy," "percutaneous," "gastrostomy," "jejunostomy," "nasogastric," "nasoenteric," "nasojejunal," "transnasal," "feeding tube," "enteric," and "button." Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
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Charlesworth P, Hallows M, van der Avoirt A. Single-Center Experience of Laparoscopically Assisted Percutaneous Endoscopic Gastrostomy Placement. J Laparoendosc Adv Surg Tech A 2010; 20:73-5. [DOI: 10.1089/lap.2009.0057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Paul Charlesworth
- Department of Pediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom
| | - Margret Hallows
- Department of Pediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom
| | - Anouk van der Avoirt
- Department of Pediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom
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