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A simple and safe minimally invasive technique for laparoscopic gastrostomy.

Kandil E, Alabbas H, Jacob C, Friedlander P, Duchesne J, Joshi V, Bellows C - JSLS (2010 Jan-Mar)

Bottom Line: Demographic and outcome data were abstracted.This innovative 2-port laparoscopic technique for gastrostomy tube placement is safe and effective.It allows for the quick, accurate, and safe insertion of the feeding tube under direct visualization and avoids open techniques in patients where PEG tubes are not feasible.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. ekandil@tulane.edu

ABSTRACT

Introduction: Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice in the nutritional management of patients requiring gastrostomies. However, PEG tubes are not always feasible. The aim of the present study was to determine the feasibility, complications, and adequacy of feeding support of a novel laparoscopic gastrostomy technique in adults where PEG tubes were neither feasible nor safe.

Methods: A retrospective chart review of patients who underwent a laparoscopic gastrostomy from August 2007 to July 2008 was performed. Demographic and outcome data were abstracted.

Results: Fourteen patients underwent laparoscopic gastrostomy. Nine had obstructing head/neck cancer, 2 had severe head trauma, and one was morbidly obese. Nine patients had previous abdominal surgery. The mean operative time was 29.8 minutes (+/-7.2). There were no conversions to open gastrostomy. Two ports (5mm and 10mm) were used in the majority of patients (78.5%). No major complications were observed. The mean follow-up was 3.1 months (range, 2 to 8).

Conclusion: This innovative 2-port laparoscopic technique for gastrostomy tube placement is safe and effective. It allows for the quick, accurate, and safe insertion of the feeding tube under direct visualization and avoids open techniques in patients where PEG tubes are not feasible.

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Related in: MedlinePlus

Digital palpation at the site of planned gastrostomy under 5-mm camera direct visualization.
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Figure 1: Digital palpation at the site of planned gastrostomy under 5-mm camera direct visualization.

Mentions: With the patient under general anesthesia, a supraumbilical or infraumbilical incision is used to establish pneumoperitoneum with either an open or closed technique. Pneumoperitoneum is created with a CO2 pressure between 5mm Hg to 10mm Hg. A 5-mm port is placed, and a 30° angled laparoscope is inserted. The table is then tilted in a reverse Trendelenburg position and by using digital palpation and laparoscopic screening; the site for the gastrostomy tube placement is chosen (Figure 1). Ideally, placement for the gastrostomy tube should be along the greater curvature. A 10- to 11-mm port is then introduced under direct vision over the designated site for the tube placement (Figure 2). This site should be at least 2cm caudal to the costal margin. The gastric wall is then grasped with a 10-mm laparoscopic Babcock forceps and brought through the port site while simultaneously removing the trocar and decreasing the pneumoperitoneal pressure to 0mm Hg (Figure 2). Once exteriorized, the gastric wall is secured with 2 Babcock forceps. Double purse-string sutures (00) are then placed at the exposed stomach, which will be used later as anchoring sutures to the peritoneum. A gastrostomy is opened at the center of the loop by diathermy. A balloon gastrostomy tube is then inserted (Figure 3). A large-size Foley catheter, mushroom catheter, or Moss tube can be used. The balloon of the feeding tube should then be positioned behind the inner purse string. The incision is sometimes enlarged up to an additional 1cm for placement of the purse-string sutures. The stomach is then pushed back to the abdominal cavity and the anchoring sutures used to attach the stomach to the anterior abdominal wall. Pneumoperitoneum (10mm Hg) is recreated to check for hemostasis and any evidence for leakage around the gastrostomy insertion site. The feeding tube is then placed to gravity, and tubal feeding is started the next day.


A simple and safe minimally invasive technique for laparoscopic gastrostomy.

Kandil E, Alabbas H, Jacob C, Friedlander P, Duchesne J, Joshi V, Bellows C - JSLS (2010 Jan-Mar)

Digital palpation at the site of planned gastrostomy under 5-mm camera direct visualization.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021287&req=5

Figure 1: Digital palpation at the site of planned gastrostomy under 5-mm camera direct visualization.
Mentions: With the patient under general anesthesia, a supraumbilical or infraumbilical incision is used to establish pneumoperitoneum with either an open or closed technique. Pneumoperitoneum is created with a CO2 pressure between 5mm Hg to 10mm Hg. A 5-mm port is placed, and a 30° angled laparoscope is inserted. The table is then tilted in a reverse Trendelenburg position and by using digital palpation and laparoscopic screening; the site for the gastrostomy tube placement is chosen (Figure 1). Ideally, placement for the gastrostomy tube should be along the greater curvature. A 10- to 11-mm port is then introduced under direct vision over the designated site for the tube placement (Figure 2). This site should be at least 2cm caudal to the costal margin. The gastric wall is then grasped with a 10-mm laparoscopic Babcock forceps and brought through the port site while simultaneously removing the trocar and decreasing the pneumoperitoneal pressure to 0mm Hg (Figure 2). Once exteriorized, the gastric wall is secured with 2 Babcock forceps. Double purse-string sutures (00) are then placed at the exposed stomach, which will be used later as anchoring sutures to the peritoneum. A gastrostomy is opened at the center of the loop by diathermy. A balloon gastrostomy tube is then inserted (Figure 3). A large-size Foley catheter, mushroom catheter, or Moss tube can be used. The balloon of the feeding tube should then be positioned behind the inner purse string. The incision is sometimes enlarged up to an additional 1cm for placement of the purse-string sutures. The stomach is then pushed back to the abdominal cavity and the anchoring sutures used to attach the stomach to the anterior abdominal wall. Pneumoperitoneum (10mm Hg) is recreated to check for hemostasis and any evidence for leakage around the gastrostomy insertion site. The feeding tube is then placed to gravity, and tubal feeding is started the next day.

Bottom Line: Demographic and outcome data were abstracted.This innovative 2-port laparoscopic technique for gastrostomy tube placement is safe and effective.It allows for the quick, accurate, and safe insertion of the feeding tube under direct visualization and avoids open techniques in patients where PEG tubes are not feasible.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. ekandil@tulane.edu

ABSTRACT

Introduction: Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice in the nutritional management of patients requiring gastrostomies. However, PEG tubes are not always feasible. The aim of the present study was to determine the feasibility, complications, and adequacy of feeding support of a novel laparoscopic gastrostomy technique in adults where PEG tubes were neither feasible nor safe.

Methods: A retrospective chart review of patients who underwent a laparoscopic gastrostomy from August 2007 to July 2008 was performed. Demographic and outcome data were abstracted.

Results: Fourteen patients underwent laparoscopic gastrostomy. Nine had obstructing head/neck cancer, 2 had severe head trauma, and one was morbidly obese. Nine patients had previous abdominal surgery. The mean operative time was 29.8 minutes (+/-7.2). There were no conversions to open gastrostomy. Two ports (5mm and 10mm) were used in the majority of patients (78.5%). No major complications were observed. The mean follow-up was 3.1 months (range, 2 to 8).

Conclusion: This innovative 2-port laparoscopic technique for gastrostomy tube placement is safe and effective. It allows for the quick, accurate, and safe insertion of the feeding tube under direct visualization and avoids open techniques in patients where PEG tubes are not feasible.

Show MeSH
Related in: MedlinePlus