Laparoscopic Gastrostomy in Children

Objective: Pediatric gastric access for long term enteral feeding, may be performed via laparotomy, laparoscopy, or a percutaneous approach. The aim of this study was to report our experience with laparoscopic video-assisted gastrostomy in children and infants as a route for gastric access. Methodology: From April 2005 to April 2009 we retrospectively reviewed 17 cases of laparoscopic assisted gastrostomy performed at New Children Hospital at West mead, Sydney - Australia and King Hussein Medical Center - Jordan, using two 5-mm working ports, one placed through an infra-umbilical incision for 5mm 0-degree scope and the other 5-mm port was placed over the stomach at the designated site for tube placement tube was placed. Results: In 17 children, the procedure was successfully completed without conversions. The median patient age at the time of surgery was four years (range, 6 months to 14 years). The mean operative time was 20 minutes (range, 15–35). When a concurrent laparoscopic nissen fundoplication was performed (n= 4) the laparoscopic gastrostomy was placed after completion of nissen fundoplication. No intra-operative complication occurred, all buttons and tubes were successfully placed, feeds were instituted the following day and advanced to goal.Minor post operative complications, such as, granulation tissue, stoma irritation, tube dislodgement, leakage from the stoma site occurred and responded well to conservative management, revision has not been necessary. Conclusion: Based on our initial experience. Laparoscopic assisted gastrostomy is feasible, safe and effective procedure in children for feeding access as an alternate to an open gastrostomy. Technically, it is a simple method not only representing an alternative to PEG when this procedure is not suitable or after failure. But, can also be widely used for patients as a first choice