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Ohgaki Y, Ishibashi Y, Hatao F, Furuta R, Saito N, Inayoshi R, Morita Y. Laparoscopically assisted percutaneous endoscopic gastrostomy performed for remnant stomach in patient with amyotrophic lateral sclerosis: a case report. Surg Case Rep 2023; 9:98. [PMID: 37280445 DOI: 10.1186/s40792-023-01683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/04/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Although percutaneous endoscopic gastrostomy (PEG) offers better access to the gastrointestinal system, in patients with previous abdominal surgery, PEG can be unsuccessful. Laparoscopically assisted percutaneous endoscopic gastrostomy (LAPEG) is indicated for such patients. However, patients with amyotrophic lateral sclerosis (ALS) may be more susceptible to anesthesia-related complications than other patients, requiring the indications for LAPEG, along with perioperative management, to be considered carefully. CASE PRESENTATION A 70-year-old, male patient with ALS was referred to our hospital for a gastrostomy for progressive dysphagia. He had undergone an open distal gastrectomy for gastric ulcer perforation in his twenties. Upper gastrointestinal endoscopy denied the transillumination sign and focal finger invagination. Because the risk of respiratory complications caused by general anesthesia was not considered serious, the decision was made to perform a LAPEG. Under careful, intraoperative airway management and neuromuscular monitoring, adhesiolysis was performed to increase mobility of the remnant stomach. A gastrostomy tube was inserted through the abdominal wall and into the remnant stomach under laparoscopic and endoscopic guidance. The patient was discharged in stable condition on postoperative day 3 without any respiratory complications. CONCLUSIONS LAPEG was able to be performed in a patient with ALS with a previous gastrectomy. A perioperative team comprised of neurologists, endoscopists, surgeons, anesthesiologists, and nurses who are fully conversant with ALS must be assembled to deal with potentially complex medical issues related to the procedure and anesthetic and perioperative management.
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Affiliation(s)
- Yutaro Ohgaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Ryuichiro Furuta
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Noriyuki Saito
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Rie Inayoshi
- Department of Anesthesiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
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Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022; 14:286-303. [PMID: 35664365 PMCID: PMC9131834 DOI: 10.4240/wjgs.v14.i4.286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
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Affiliation(s)
- Anand Rajan
- Department ofGastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | | | - Jonathan Kessler
- Department ofInterventional Radiology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Trilokesh Dey Kidambi
- Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
| | - James H Tabibian
- Department ofGastroenterology, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
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Duza G, Palermo M, Serra E, Davrieux F. Chronic Gastric Dilation-Surgical Management. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34534020 DOI: 10.1089/lap.2021.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic dilation of the gastric remnant is a rare complication, although it can be serious. It is due to an exaggerated distension of the gastric remnant after a Roux-en-Y gastric bypass (RYGB). Clinical suspicion and computed tomography (CT) are essential for its diagnosis. Its treatment is by means of a decompressive gastrostomy, which can be percutaneous or surgical, an option that can be carried out in certain patients. We present a clinical case of chronic dilation of the gastric remnant and its laparoscopic surgical resolution. Methods: We present a clinical case of a 67-year-old patient who underwent a RYGB. An abdominal CT scan showed chronic dilation of the gastric remnant. A laparoscopic biopsy and a laparoscopic-assisted percutaneous gastrostomy were performed. Conslusion: The combined percutaneous laparoscopic approach is a good option for cases of chronic gastric dilations of unknown origin, allowing to discover and treat its causes.
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Affiliation(s)
- Guillermo Duza
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Department of Bariatric Surgery, DIAGNOMED, Buenos Aires, Argentina
| | - Mariano Palermo
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Department of Bariatric Surgery, DIAGNOMED, Buenos Aires, Argentina
- Department of Percutaneous Surgery, DAICIM Foundation, Buenos Aires, Argentina
| | - Edgardo Serra
- Department of Percutaneous Surgery, DAICIM Foundation, Buenos Aires, Argentina
- Department of Bariatric Surgery, CIEN Center, Corrientes, Argentina
| | - Federico Davrieux
- Department of Percutaneous Surgery, DAICIM Foundation, Buenos Aires, Argentina
- Department of General Surgery, Sanatorio de la Mujer, Rosario, Argentina
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Relationship of early acute complications and insertion site in push method percutaneous endoscopic gastrostomy. Sci Rep 2020; 10:20551. [PMID: 33239745 PMCID: PMC7689522 DOI: 10.1038/s41598-020-77553-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG), which is frequently used for nutrition management in patients having difficulty with oral intake, is considered a safe procedure. However, serious complications may occur depending on site of the puncture. This study aimed to clarify whether push method PEG construction at the posterior wall (PW) of the greater curvature (GC) had a higher risk of complications. We retrospectively investigated the relationship between puncture site at the PW of the GC and early acute complications in 540 patients receiving PEG. Early acute complications were defined as bleeding or perforation within 30 days after the PEG procedure. PEG-related complications were observed in 80 patients in total, with early acute complications detected in 42 patients. PEG construction at the PW of the GC in 12 cases exhibited a significantly higher occurrence of early acute complications versus PEG at other sites (41.7% vs. 7.0%, p = 0.001). Further, multivariate analysis revealed PW at the GC to be independently associated with early acute complications (OR 9.59, 95% CI 2.82-32.61; p = 0.0003). It may be desirable to avoid PEG at the PW of the GC. If performed, clinicians should pay careful attention to early acute complications.
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Sayadi Shahraki M, Berjis N, Bighamian A, Mahmoudieh M, Shahabi Shahmiri S, Sheikhbahaei E. Minimally invasive technique for gastrostomy tube insertion: A novel laparoscopic approach. Asian J Endosc Surg 2020; 13:610-613. [PMID: 31930718 DOI: 10.1111/ases.12780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/31/2019] [Accepted: 12/01/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) is the most common way of inserting a gastrostomy tube. If PEG is not appropriate for a patient, then the laparoscopic or open technique should be used. Here, we introduce a new laparoscopic technique for inserting a gastrostomy tube. MATERIAL AND SURGICAL TECHNIQUE We used this new laparoscopic approach in 21 patients for whom PEG was not suitable. After marking on the abdominal skin and inserting the trocars, two 2-0 silk sutures were passed. Two stitches were placed 2 cm apart in the stomach with one hand. Each suture was pulled out with the fascia closure, the stomach was pulled out with a Babcock, and a purse-string suture using a round 2-0 silk suture was placed outside the stomach, creating a mushroom-retained gastrostomy. CONCLUSION This new laparoscopic technique is minimally invasive. It provides full control through only two trocars and required smaller incisions than common laparoscopic approaches. This method can be used to insert a gastrostomy tube in indicated patients when PEG placement is not suitable.
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Affiliation(s)
- Masoud Sayadi Shahraki
- Laparoscopic Surgery Fellowship, Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nezamoddin Berjis
- Otorhinolaryngology Department, Kashani University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Bighamian
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Mahmoudieh
- Laparoscopic Surgery Fellowship, Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahab Shahabi Shahmiri
- Laparoscopic Surgery Fellowship, Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Lodin D, Gupta AK, Rubay D, Genuit T, Hus N. The Effectiveness of Laparoscopic-assisted Percutaneous Endoscopic Gastrostomy in Patients with Unfavorable Anatomy: A Single-center Retrospective Cohort Study. Cureus 2020; 12:e6647. [PMID: 31976184 PMCID: PMC6968833 DOI: 10.7759/cureus.6647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an easy means to provide enteral access in patients unable to maintain adequate nutrition via the oral route. In patients with morbid obesity, altered intra-abdominal anatomy due to prior abdominal surgery, the interposition of the colon or other factors precluding endoscopy, feeding tube placement by laparoscopic means (LAPEG) can provide a potentially safe alternative. The objective of this study was to examine the efficacy and outcomes of laparoscopic-assisted placement of PEG in adult patients. This is a retrospective cohort analysis of adult patients, who underwent PEG and/or laparoscopic-assisted percutaneous endoscopic gastrostomy placement (LAPEG) by two surgeons at a single institution. A total of 36 patients underwent PEG and/or LAPEG. No significant differences were found in the total and postoperative length of stay and mortality. There were no procedure-related complications in the LAPEG group versus two in the PEG group (8.7%), but this did not reach statistical significance. LAPEG was 100% successful in gaining enteral feeding access in patients that had failed PEG. The most common reason for PEG placement failure was colonic interposition (39%), followed by intra-abdominal adhesions and gastric displacement by hiatal hernia (each 23%). 38.5% of LAPG procedures could be done via 5-mm single port access, 38.5% required two-port and 23% required three-port access. In conclusion, LAPEG is a feasible minimally invasive alternative to gain enteral feeding access in patients that have failed PEG that does not increase the length of stay, morbidity or mortality.
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Affiliation(s)
- Daud Lodin
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Anupam K Gupta
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - David Rubay
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Thomas Genuit
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Nir Hus
- Surgery, Delray Medical Center, Delray Beach, USA
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Tanaka T, Ueda T, Yokoyama T, Sadamitsu T, Yoshimura A, Horiuchi H, Sawai M, Matsumoto M. Laparoscopic Percutaneous Endoscopic Gastrostomy Is Useful for Elderly. JSLS 2019; 23:JSLS.2019.00011. [PMID: 31148916 PMCID: PMC6535467 DOI: 10.4293/jsls.2019.00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: In recent years, enteral nutrition has become relatively easy to perform through the penetration of percutaneous endoscopic gastrostomy (PEG). However, there have been reports of complications, such as mispuncture of other organs at the time of performing PEG. Previously, we had constructed a gastrostomy under the laparotomy for difficult PEG cases, and 2 years ago, we introduced laparoscopically assisted PEG. This study aimed to clarify the feasibility and safety of LAPEG for elderly people over 65 years old. Methods: We evaluated the perioperative outcomes in 7 elderly patients who underwent LAPEG during these 2 years. In these subjects, the safety of LAPEG was evaluated retrospectively based on the surgical outcomes, perioperative complications, and postoperative course using the clinical archives. Results: The subjects' mean age was 81.1 ± 8.03 years. LAPEG was successful in all 7 patients. The median operation time was 38 minutes (range, 31–71 minutes). Intraoperative and postoperative early or late complications from LAPEG were not observed in our cases. Enteral nutrition was commenced 2 days after PEG placement in all cases without complications. Conclusion: We summarized the LAPEG cases performed at our institution for the elderly, and have reported its feasibility and safety. The strongest advantage of LAPEG was that it allowed placement of the PEG without any complication under direct observation of the intraperitoneal cavity to confirm the safety of each organ.
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Affiliation(s)
- Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Takeshi Ueda
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Takashi Yokoyama
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Tomomi Sadamitsu
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Hazuki Horiuchi
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
| | - Masayoshi Sawai
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
| | - Masami Matsumoto
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
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Sartori A, De Luca M, Lunardi C, Clemente N, Segato G, Rossi G, De Luca A, Minni M, Colaut F, Fortunato C, Nicolì F, Castiglioni C, Pellicanò N, Scaffidi G, De Marchi F. Laparoendoscopic Percutaneous Endoscopic Gastrostomy in Adults. J Laparoendosc Adv Surg Tech A 2018; 28:1192-1195. [DOI: 10.1089/lap.2018.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Maurizio De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Cesare Lunardi
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Nicola Clemente
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Gianni Segato
- Department of Surgery, Regional Hospital of Vicenza, Vicenza, Italy
| | - GianMaria Rossi
- Department of Surgery, Regional Hospital of Vicenza, Vicenza, Italy
| | - Alberto De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Massimo Minni
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Flavio Colaut
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Costanzo Fortunato
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Francesco Nicolì
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Cristina Castiglioni
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Natale Pellicanò
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
| | - Guido Scaffidi
- Department of General Surgery, San Valentino Hospital, Montebelluna, Treviso, Italy
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Hansen E, Qvist N, Rasmussen L, Ellebaek MB. Postoperative complications following percutaneous endoscopic gastrostomy are common in children. Acta Paediatr 2017; 106:1165-1169. [PMID: 28374507 DOI: 10.1111/apa.13865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/13/2017] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
Abstract
AIM Inserting a feeding tube using percutaneous endoscopic gastrostomy may be necessary to ensure that children with eating problems receive sufficient enteral nutrition. The aim of this study was to investigate the perioperative and postoperative complications of percutaneous endoscopic gastrostomy when the pull-through method was the standard procedure. METHODS This was a retrospective review of 229 children (50.7% male) who underwent a gastrostomy procedure at Odense University Hospital, Denmark, from January 1, 2000 to December 31, 2012. The median age of the children was 1.6 years (range: 0-14.9), and the follow-up period was 36 months. Complications were graded according to the Clavien-Dindo classification. RESULTS A total of 167 postoperative complications occurred in 118 of the 229 patients (51.5%). Of these, 89 were grade 1 complications, 49 were grade 2 complications, and 29 were grade 3b complications. No gastrostomy-related deaths were observed, and no single preoperative risk factor was identified. Perioperative complications were experienced by 2.6% of the patients. CONCLUSION Gastrostomy feeding tube placement was associated with a high rate of postoperative complications of various grades when the pull-through method was the standard procedure. A consensus on how to report and grade complications arising from this procedure is warranted.
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Affiliation(s)
- E Hansen
- Department of Surgery; Odense University Hospital; Odense Denmark
| | - N Qvist
- Department of Surgery; Odense University Hospital; Odense Denmark
| | - L Rasmussen
- Department of Surgery; Odense University Hospital; Odense Denmark
| | - MB Ellebaek
- Department of Surgery; Odense University Hospital; Odense Denmark
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Abstract
There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible. For these challenging situations, laparoscopic-assisted PEG (LAPEG) is an alternative option. LAPEG combines the advantages of PEG with direct intraperitoneal visualization, helping ensure a safe tube placement tract free of intervening organs or structures. In this review, we highlight some of the important factors of first-line gastrostomy techniques, with an emphasis on the utility and procedural technique of LAPEG when they are not feasible.
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Affiliation(s)
- Adarsh M Thaker
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA.
| | - Alireza Sedarat
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, PVUB 2114, MC 694907, Los Angeles, CA, 90095-6949, USA
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11
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Vasseur Maurer S, Reinberg O. Laparoscopic technique to perform a true Stamm gastrostomy in children. J Pediatr Surg 2015; 50:1797-800. [PMID: 26170215 DOI: 10.1016/j.jpedsurg.2015.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE A surgical gastrostomy is mandatory in cases where a PEG is not feasible. Various minimally invasive techniques have been described, but many involve unusable materials in small children and/or have risk of disunion. We describe a technique for true Stamm gastrostomy performed by laparoscopy (LSG) with a purse string suture and four points of attachment onto the wall. METHOD We reviewed 20 children who underwent an LSG from 2010 to 2013. After incision of the skin at the location planned for the gastrostomy, using three 3-5mm ports the stomach is fixed to the wall by three suspension stitches, which are entered and then emerged subcutaneously. A fourth stitch of attachment is used to make an award on the stomach and tie around the gastrostomy tube. RESULTS Mean age was 4.2 years, with 70% aged <2 years. All children were malnourished, most often severely. All but two underwent a concomitant fundoplication. Feeding through the gastrostomy started on D0 or D1. Total feeding by gastrostomy was achieved in a mean duration of 2.9 day. Mean hospital stay was 4.5 days. There was no perioperative complication. Mean follow-up was 14 months. Once, the balloon was accidently deflated and reinflated in the wall leading to its necrosis. Five peristomial granulomas were noticed. It was always possible to replace the tube by a gastrostomy device at least 6 weeks after surgery. CONCLUSION This new technique for true Stamm gastrostomy by laparoscopy reproduces exactly the one done by laparotomy, without special equipment. It can be made since the neonatal period, in all the circumstances when a laparoscopy is possible.
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Affiliation(s)
- Sabine Vasseur Maurer
- Department of Pediatric Surgery, University Hospital Center and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - Olivier Reinberg
- Department of Pediatric Surgery, University Hospital Center and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
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12
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Abbassi Z, Naiken SP, Buchs NC, Staszewicz W, Giostra E, Morel P. Laparoscopic-assisted percutaneous endoscopic gastrostomy in two patients who failed percutaneous endoscopic gastrostomy. Int J Surg Case Rep 2015; 13:40-2. [PMID: 26101053 PMCID: PMC4529636 DOI: 10.1016/j.ijscr.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) is a common procedure to obtain a feeding tube. However, this technique might imply several difficulties and complications. The inability to transilluminate the abdominal wall may occur frequently, especially in obese or multi-operated patients. With the emergence of minimally invasive surgery, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) might provide a safe and efficient alternative. PRESENTATION OF CASES We report hereby two cases of patients having undergone LAPEG in our institution. Conventional PEGs were deemed impossible because of the absence of transillumination and motivated a surgical approach. Two obese patients with a Body Mass Index (BMI) of 31 and 45kg/m(2) respectively presented neurological condition (stroke and Parkinson's disease) requiring a feeding tube. While a PEG was unsuccessful (impossibility to transilluminate), a LAPEG was attempted. The procedure and the recovery were uneventful. DISCUSSION There are different techniques for gastrostomy tube placement: open gastrostomy, PEG and radiologic procedure. The PEG is associated with a significant risk of bowel perforation. LAPEG seems to be an interesting option in order to avoid an open gastrostomy in patients in whom a PEG cannot be performed. This is especially true in obese patients, where a transillumination cannot be performed. It offers an endoscopic view of the stomach simultaneously to the laparoscopic approach that allows a potential decrease of major complications. CONCLUSION While the literature reports mainly pediatric cases, we present herein two successful LAPEG in adult obese patients. In case of impossibility to perform PEG, this technique allows a safe direct visualization of the stomach and other adjacent organs.
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Affiliation(s)
- Ziad Abbassi
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland.
| | - Surennaidoo P Naiken
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Nicolas C Buchs
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Wojciech Staszewicz
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Emiliano Giostra
- Division of Gastroenterology, University Hospital of Geneva, Geneva, Switzerland
| | - Philippe Morel
- Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland
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Zhang SX, Wang HB, Zhang H, Liu HF, Zhou ZF, Zhang JT, Gao L. Pilot laparoscopic ileal cannulation in pigs. CANADIAN JOURNAL OF ANIMAL SCIENCE 2014. [DOI: 10.4141/cjas2013-171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Zhang, S. X., Wang, H. B., Zhang, H., Liu, H. F., Zhou, Z. F., Zhang, J. T. and Gao, L. 2014. Pilot laparoscopic ileal cannulation in pigs. Can. J. Anim. Sci. 94: 371–377. Pilot laparoscopic ileal cannulation was performed in eight anesthetized pigs (40.5±1.9 kg) positioned in dorsal recumbency using three portals in the abdomen. The T-shaped ileal cannulation site was located 15 cm anterior to the ileocecal valve on the antimesenteric section of the ileum. A transabdominal suspension suture was placed approximately 3 cm caudal to the ileal cannulation site. A purse-string suture was placed first around the insertion site, and a stab incision was made in the middle of the purse-string suture. The T-shaped cannula was inserted into the ileal lumen through the stab incision, and the purse-string suture was tightened. The T-shaped ileal cannula was pulled out of the abdominal cavity through the exit wound located 3–5 cm lateral and 10–12 cm caudal to the right or left side of the umbilicus. The transabdominal suspension suture was then removed. The T-shaped cannula was secured to the skin with a finger-trap suture. Surgical time and complications were recorded. Repeat laparoscopy was performed 35 d later. No major intraoperative or postoperative complications were encountered. The ileal contents were collected easily. On repeat laparoscopy, firm adhesion between the ileum and the abdominal wall was observed in all pigs, and there was no evidence of digesta leakage or consequential peritonitis.
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Affiliation(s)
- S. X. Zhang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, P.R. China
| | - H. B. Wang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, P.R. China
| | - H. Zhang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, P.R. China
| | - H. F. Liu
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, P.R. China
| | - Z. F. Zhou
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, P.R. China
| | - J. T. Zhang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, P.R. China
| | - L. Gao
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, P.R. China
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14
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Mimatsu K, Oida T, Kida K, Fukino N, Kawasaki A, Kano H, Kuboi Y, Amano S. Simultaneous laparoscopic Nissen fundoplication and percutaneous endoscopic gastrostomy to treat an elderly patient with a large paraesophageal hernia: a case report. Asian J Endosc Surg 2014; 7:165-8. [PMID: 24754880 DOI: 10.1111/ases.12081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/25/2013] [Accepted: 11/17/2013] [Indexed: 12/25/2022]
Abstract
Laparoscopic Nissen fundoplication (LNF) and gastrostomy are often performed in children with gastroesophageal reflux disease. With a population that is increasingly aging, the number of elderly patients with paraesophageal hernia who have a nutritional disorder due to dysphagia has increased. In these patients with feeding difficulties, LNF and percutaneous endoscopic gastrostomy (PEG) are effective procedures for providing nutritional support. Here, we describe the case of an 82-year-old woman with paraesophageal hernia and certain comorbidities. She was receiving enteral feeding through a nasogastric tube, which was discontinued because aspiration pneumonia occurred. Therefore, LNF and crural repair without mesh placement were performed. The PEG tube was placed using the Ponsky pull technique under direct visualization with a laparoscope and gastroscope. The patient's nutritional status improved after she received enteral nutrition through the PEG tube. Thus, LNF and PEG may be useful techniques for nutritional support in elderly patients with a large paraesophageal hernia.
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Affiliation(s)
- Kenji Mimatsu
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan
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15
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Abstract
PURPOSE OF REVIEW Enteral nutrition support is often required in patients who are unable to meet their own nutritional requirements. Endoscopists play a key role in the placement of enteral feeding catheters. This review focuses on the recently published solutions to common problems encountered during endoscopic placement of enteral feeding devices. RECENT FINDINGS Case reports and case series describe solutions for overcoming common problems encountered during the placement of enteral feeding devices. Transnasal techniques can simplify nasojejunal tube placement, whereas deep enteroscopy techniques provide more reliable jejunostomy placement. Endoscopic ultrasound can help when transillumination is not possible or in the setting of postsurgical anatomy like Roux-en-Y. Laparoscopic-assisted procedures are useful when endoscopic techniques have failed in adults or in select high-risk pediatric patients. The American Society for Gastrointestinal Endoscopy and the American Gastroenterology Association both published comprehensive guidelines that outline the indications, contraindications, technical aspects of feeding catheter placement, and complications. SUMMARY Advances in endoscopic techniques, including deep enteroscopy, endoscopic ultrasound, ultra-slim transnasal endoscopes and laparoscopic-assisted procedures, have enabled endoscopists to successfully place enteral feeding tubes in patients who previously required open procedures.
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