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Laparoscopic-assisted percutaneous endoscopic gastrostomy tube placement.

Lopes G, Salcone M, Neff M - JSLS (2010 Jan-Mar)

Bottom Line: All patients referred for surgical feeding tube placement after unsuccessful PEG were considered for LAPEG.Eight patients who underwent an unsuccessful PEG were taken to the operating room for LAPEG.All patients had successful LAPEG placement.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, US Air Force, Eglin Air Force Base Hospital, FL 32542, USA. gustavo@lopes-usa.net

ABSTRACT

Background: Percutaneous endoscopic gastrostomy (PEG) is the most common way of placing a feeding tube. Sometimes PEG cannot be used to safely place a feeding tube, most commonly secondary to an inability to transilluminate the abdominal wall. Whereas open gastrostomy was previously necessary in such cases, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) is a viable option and is reviewed here.

Methods: All patients referred for surgical feeding tube placement after unsuccessful PEG were considered for LAPEG. A diagnostic laparoscopy was performed to identify the reason for the failed PEG attempt. Additional ports were placed as needed for the retraction of organs and lysis of adhesions. The stomach was visualized, and the PEG was placed.

Results: Eight patients who underwent an unsuccessful PEG were taken to the operating room for LAPEG. All patients had successful LAPEG placement. No postoperative complications occurred. The most common reason identified for failed PEG attempt was adhesions followed by overlying organs. Average OR time was 32 minutes.

Conclusion: When conventional PEG placement is not possible, LAPEG placement should be considered as a time efficient, minimally invasive alternative to open gastrostomy.

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Related in: MedlinePlus

White arrow on stomach. Black arrow on overriding colon with hematoma from previous percutaneous endoscopic gastrostomy attempt.
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Figure 1: White arrow on stomach. Black arrow on overriding colon with hematoma from previous percutaneous endoscopic gastrostomy attempt.

Mentions: Patients were brought into the operating room and placed under general anesthesia. A 5-mm optical trocar was used to gain access to the abdominal cavity in the right upper quadrant. If the patient had previous surgery in the right upper quadrant, the left upper quadrant was used instead. The abdomen was then explored to identify the reason for the PEG failure (Figure 1). The stomach was then visualized and positioned for PEG insertion. This was done by positioning the patient in a reverse Trendelenburg, retracting any overlying organs, and lysis of adhesions as needed. One or two additional ports were placed to aid in this task.


Laparoscopic-assisted percutaneous endoscopic gastrostomy tube placement.

Lopes G, Salcone M, Neff M - JSLS (2010 Jan-Mar)

White arrow on stomach. Black arrow on overriding colon with hematoma from previous percutaneous endoscopic gastrostomy attempt.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021284&req=5

Figure 1: White arrow on stomach. Black arrow on overriding colon with hematoma from previous percutaneous endoscopic gastrostomy attempt.
Mentions: Patients were brought into the operating room and placed under general anesthesia. A 5-mm optical trocar was used to gain access to the abdominal cavity in the right upper quadrant. If the patient had previous surgery in the right upper quadrant, the left upper quadrant was used instead. The abdomen was then explored to identify the reason for the PEG failure (Figure 1). The stomach was then visualized and positioned for PEG insertion. This was done by positioning the patient in a reverse Trendelenburg, retracting any overlying organs, and lysis of adhesions as needed. One or two additional ports were placed to aid in this task.

Bottom Line: All patients referred for surgical feeding tube placement after unsuccessful PEG were considered for LAPEG.Eight patients who underwent an unsuccessful PEG were taken to the operating room for LAPEG.All patients had successful LAPEG placement.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, US Air Force, Eglin Air Force Base Hospital, FL 32542, USA. gustavo@lopes-usa.net

ABSTRACT

Background: Percutaneous endoscopic gastrostomy (PEG) is the most common way of placing a feeding tube. Sometimes PEG cannot be used to safely place a feeding tube, most commonly secondary to an inability to transilluminate the abdominal wall. Whereas open gastrostomy was previously necessary in such cases, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) is a viable option and is reviewed here.

Methods: All patients referred for surgical feeding tube placement after unsuccessful PEG were considered for LAPEG. A diagnostic laparoscopy was performed to identify the reason for the failed PEG attempt. Additional ports were placed as needed for the retraction of organs and lysis of adhesions. The stomach was visualized, and the PEG was placed.

Results: Eight patients who underwent an unsuccessful PEG were taken to the operating room for LAPEG. All patients had successful LAPEG placement. No postoperative complications occurred. The most common reason identified for failed PEG attempt was adhesions followed by overlying organs. Average OR time was 32 minutes.

Conclusion: When conventional PEG placement is not possible, LAPEG placement should be considered as a time efficient, minimally invasive alternative to open gastrostomy.

Show MeSH
Related in: MedlinePlus