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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

Approximation of gastric and abdominal walls.
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Figure 3: Approximation of gastric and abdominal walls.

Mentions: An upper endoscopy was performed simultaneously with the laparoscope still in place. The abdominal insufflation pressure was decreased from 15 mm Hg to 6 mm Hg. The PEG was then placed under direct visualization by using the Ponsky pull technique via a small stab incision in the left upper quardrant.9 The separate incision was used to maintain a snug fit around the tube and avoid the leakage that is typically associated with using one of the larger 5-mm port sites. The needle placement into the stomach and the approximation of the gastric and abdominal walls were confirmed visually (Figures 2 and 3).


Laparoscopic-assisted percutaneous endoscopic gastrostomy tube placement.

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

Approximation of gastric and abdominal walls.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Approximation of gastric and abdominal walls.
Mentions: An upper endoscopy was performed simultaneously with the laparoscope still in place. The abdominal insufflation pressure was decreased from 15 mm Hg to 6 mm Hg. The PEG was then placed under direct visualization by using the Ponsky pull technique via a small stab incision in the left upper quardrant.9 The separate incision was used to maintain a snug fit around the tube and avoid the leakage that is typically associated with using one of the larger 5-mm port sites. The needle placement into the stomach and the approximation of the gastric and abdominal walls were confirmed visually (Figures 2 and 3).

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