Page 12 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

place the feeding tube: the percutaneous endoscopic gastrostomy (PEG). 15 Advantages of PEG reflect its less traumatic nature: lower costs, shorter procedure times and higher tolerance for early postoperative feeding. 16 Nowadays, many institutes use PEG as the standard approach in pediatric patients. However, lack of direct visualization of the intraabdominal cavity and subsequent possible injury to surrounding organs is the most imminent disadvantage of this technique. 4 In 1990, laparoscopic GP was introduced as a safe and effective minimally invasive alternative to PEG. 17 This technique provides a combination of the minimally invasive advantages of the PEG with the safety of direct visualization of the stomach during gastrostomy placement. 14 However, although both minimally invasive techniques are nowadays widely used, still no consensus exists on which type is the preferred procedure in children.
surgical procedure of laparoscopic GP
An infra-umbilical 6 mm trocar is introduced for the camera. Between the umbilicus and the costal margin, a small incision is made through which a Babcock clamp is introduced to grasp the lateral wall of the corpus under
direct laparoscopic view. This part of the
stomach is then sutured to the fascia of
the abdominal wall with Vicryl sutures in
four directions. The stomach is insufflated.
With clear laparoscopic view a needle is
inserted into the stomach. A peel-away
dilator is placed using the Seldinger
technique followed by introduction of a
gastrostomy catheter. Finally, the balloon
of the catheter is inflated with sterile
water. Feeding through the gastrostomy,
with half of the normal feeding regimen,
is initiated on the first postoperative day.
Full enteral feeding is administered on the
second day after surgery. Figure 1. surgical technique
efficacy
The most important reason for caregivers to eventually choose for a gastrostomy tube placement is the improvement of nutritional status and quality of life of their child. 18 In the majority of patients, GP is successful because sufficient caloric intake can be provided through the gastrostomy. 19 However, little is known about the long-term efficacy of GP, with either weight and height values or records of long-term postoperative method of feeding.
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