Tertiary centre experience of laparoscopic-assisted percutaneous endoscopic gastrostomy in children: A 9-year review.

Abstract

Objectives: Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) is a wellrecognised technique used for the placement of gastrostomies in patients with complex medical conditions or postsurgical difficult anatomy. We introduced LAPEG in our centre to improve outcome and increase safety in our complex paediatric population. We aim to review the outcome and complications of LAPEG in children since our change in practice. Methods: A retrospective tertiary centre review over 9 years (September 2010- September 2019) was conducted. Children under 16 years undergoing LAPEG were reviewed for risk factors and major complications. Results: 76 patients were identified, 44 males. Median age was 1 year (1 month–14 years), median weight was 8.4 kg (2.8-33.9 kg). A third was less than 7 kg and a third were in Paediatric Intensive Care Unit at the time of the procedure. A quarter had underlying congenital heart disease, a quarter had previous abdominal surgery and 15% (11/76) had American Society of Anaesthesia score of 4. The median procedure time was 29 min (18-83 min). No patient required conversion into open surgery. There was no adjacent bowel or organ injury, fistula formation, intraperitoneal leek, bleeding and no complications requiring surgical intervention. Three patients (3.9%) experienced early tube dislodgement. All dislodged gastrostomies were successfully replaced at bedside. Conclusions: LAPEG in our study was a safe method for gastrostomy insertion particularly in our complex high-risk patients. The procedure’s high safety profile appears to stem out of direct visualization of the gastrostomy tube insertion process during the entire course of the procedure.