Page 33 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Two studies reported on the success of the procedure, showing a completion rate of almost 100% after both PEG and LGP17 and a conversion rate of only 3–5%.16 This is similar to recently published prospective studies on gastrostomy placement. 6,30,31 The learning curve or level of training of the physician may be of influence on the surgical outcome, however, none of the studies reported details on surgical and/or endoscopic training.
Many publications reported on the effects of gastrostomy placement on GER. 15,32-34 However, the exact correlation between gastrostomy and the development of GER remains unclear. 35 In this systematic review, none of the comparative studies between PEG and LGP reported on GER. Perhaps this lack of published data is caused by the fact that the majority of children requiring long-term enteral tube feeding are neurologically impaired and that specifically in this group evaluation of GER is difficult. GER symptoms are often atypical, and may be disguised by other gastrointestinal problems. Furthermore, normal values of 24-hour pH monitoring are not available for children and adolescents, with the exception of early infancy. 36-38
Meta-analysis of serious adverse events identified that patients undergoing PEG had a higher risk (RR 5.55) of injury to the adjacent bowel. PEG is placed from an endoscopic intragastric view, in which a needle is introduced through the abdominal wall without a view on the position of adjacent organs. Major complications, such as adjacent bowel injuries and catheter misplacement are therefore more common after PEG compared to LGP. 39-42 Furthermore, when such complications occurred, endoscopic view could not provide early detection, which may have led to more morbidity.
Zamakhshary et al. 17 reported transcolonic tube placement in three children. In all three children, this was diagnosed postoperatively after faecal drainage via the gastrostomy. In none of the patients undergoing LGP adjacent bowel injuries occurred. The laparoscopic approach is possibly safer as it provides a clear intra-abdominal view, thereby preventing adjacent bowel injury. 43,44 Moreover, laparoscopic surgery can detect and immediately correct major complications during this primary procedure.
The meta-analysis of early tube dislodgement identified a seven times higher risk of dislodgement for children undergoing PEG than for those undergoing LGP. Tube dislodgement can lead to serious complications, such as intraperitoneal leakage of gastric content, mainly when the gastrostomy was recently performed. 45 During a LGP, the stomach is always firmly attached to the abdominal wall with several sutures. If early tube dislodgement occurs, replacement with a new catheter during an outpatient procedure can be performed with a negligible chance of developing adverse events. 16 Patients with a PEG initially only have the gastrostomy tube itself to attach the stomach to the abdominal
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