Page 32 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken
P. 32
tube change was included in the overall operating time. 17 These were the only two studies 16,17 describing the specific procedure for the PEG, both using the technique described by Gauderer et al. 5 Three studies described the LGP technique.16,17,29 Techniques described were the ‘four tacking sutures technique’16 and the ‘two anchoring sutures combined with a purse string suture’. 17
Table 3. operating time
Legend: SD = Standard deviation; * routine postoperative tube change was included in the overall operating time
Only one study compared procedural costs of both initial procedures. 29 Lee et al. concluded that PEG (1375 USD) resulted in lower procedural costs than LGP (2425 USD), which was explained by the fact that PEG required shorter operating time. However, the costs of the routine second procedure after PEG (to change the gastrostomy catheter to a button) were not included in the total costs.
None of the studies reported exact data comparing length of hospital stay and hospital costs after both PEG and LGP.
After constructing funnel plots, we did not identify evidence indicating publication bias for these secondary outcomes and none of the studies fell outside the 95% CI limits.
DisCUssion
This systematic review and meta-analysis on PEG versus LGP showed similar success rates in terms of completion or conversion of both procedures, but less major adverse events after LGP.
The most important indication for gastrostomy tube placement in children is to provide successful enteral feeding, as this leads to improvement of nutritional status and QoL. Nevertheless, in this systematic review, we found a lack of studies comparing the efficacy of enteral feeding or effects on QoL between PEG and LGP since none of the studies reported on these outcomes.
study (year)
Period
operating time PeG (min ± sD)
operating time LGP (min ± sD)
p-value
Akay 2010
2004-2008
25.6 ± 2.4
51.0 ± 2.8
0.001
Zamakhshary 2005
2002-2003
53.7 ± 3.2*
54.4 ± 2.6*
NS
30
