Laparoscopic gastrostomy in infants and children

Gastrostomy is a common procedure in children. Percutaneous endoscopic gastrostomy (PEG) is less traumatic than open surgery, but carries a higher risk in small children. We report our experience with laparoscopic gastrostomy, which appears to combine the advantages of the PEG and the safety of an open operation. Operative technique: An umbilical port (5 or 10 mm, depending on the patient's weight) and a left subcostal cannula (site of the future gastrostomy) are used. The stomach is pulled to the abdominal wall with two T-anchors, and the gastrostomy is performed using the Seldinger technique. A 17-Fr peel-away sheath is placed, through which a 5 mm endoscope is introduced to confirm its intragastric position. A 14-Fr balloon gastrostomy tube or button is then introduced. Results: Fifty-one children, aged 0 to 19 years (mean 4.4 ± 6.4 years), underwent a total of 54 laparoscopic gastrostomies in a 42-month period. Thirty-three patients were younger than 2 years, and 22 weighed less than 5 kg. Thirty-three children had failure-to-thrive, 12 suffered from cerebral palsy and 8 from cystic fibrosis. Operative time was 33.6 ± 14.3 minutes; in 18 cases, a concomitant Nissen fundoplication was performed (total operative time 76.5 ± 58.7 minutes). In all cases, gastrostomy feedings were started the following day, and hospital stay in the gastrostomy-only group was 3.3 ± 0.6 days. There were two (recognized) perforations of the back wall of the stomach, which were repaired laparoscopically, and two tube dislodgments, at 24 hours and at 4 months, requiring reoperation. Conclusions: Laparoscopy allows a quick and simple technique of gastrostomy placement under direct vision in even the smallest newborn and infant. It carries minimal operative risks and allows initiation of feedings within 24 hours.