Page 34 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

wall. Therefore, during the first week after initial placement, the tract may not be stable enough to safely exchange or reinsert the gastrostomy tube. To underline this, in this meta-analysis, we found that all patients with early tube dislodgement after PEG required reintervention under general anaesthesia. 16
A new technique with a modified T-fastener PEG has been developed to secure a more tight connection and, therefore, it is thought to provide less morbidity in the case of dislodgement. 46 Unfortunately, the authors did not separately report on using T-fasteners during PEG. Therefore, comparison of PEG with T-fasteners to PEG without T-fasteners is not possible.
In 8.4% (2.1–19.4%) of children who underwent PEG a reintervention requiring general anaesthesia was needed, while in children who underwent LGP only 2.5% (0–8.6%) returned to the operating theatre for reintervention. Meta-analysis confirmed a significant difference (RR = 2.79; p = 0.0008) in favour of LGP. General anaesthesia can be hazardous, especially in patients with cardiac and/or pulmonary anomalies. Therefore, specifically in these patients, LGP could be preferred in order to minimize the risk of multiple (routine) procedures under general anaesthesia.47
Minor complications may play an important role in QoL of patients and their caretakers, especially in children with a long-term indication for gastrostomy use. 48 Stomal infection and leakage of gastric contents at the gastrostomy site were similar after PEG and LGP. Nevertheless, infection rates are difficult to compare because studies do not specify if these infections were confirmed by positive wound cultures or if patients were treated with antibiotics. Hypergranulation is a complication that occurs very frequently after gastrostomy placement. It can cause bleeding and leakage from the gastrostomy site and can be reason for reoperation and thus have a major influence on QoL. 6 However, no studies could be identified comparing the incidence of postoperative hypergranulation between PEG and LGP.
PEG is thought to be a faster procedure than LGP; in this study, only two studies compared operating time, of which only one found a significant difference in favour of PEG.16 In the study by Zamakhshary et al. 17 PEG and LGP required similar operating time, possibly because the operating time of the second routine procedure (to change the gastrostomy tube to a button) was included in the operating time of PEG. In PEG, even though the initial placement required less operating time, most patients required a second procedure under anaesthesia for routine tube change. In patients who underwent LGP, this routine tube change could be performed in the outpatient clinic. 17,49 The surgeon should take the need for a second procedure under general anaesthesia after PEG into consideration.
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