Primary laparoscopic button gastrostomy in infants and children

Abstract

SUMMARY
Aim: Laparoscopic gastrostomy in children has recently
become an established minimally invasive alternative to
endoscopic insertion. The authors describe a method of
primary laparoscopic button gastrostomy, in order to
emphasize certain technical modifications that make it
safer, simpler and more effective than previously reported
techniques.
Materials and methods: The medical records of 17 children
who underwent primary laparoscopic button gastrostomy
are reviewed. The Seldinger technique was used for the
button insertion and the stomach was fixed to the
epigastrium with two U-sutures. The modifications of our
technique as compared to others are: 1) the tract is
minimally dilated to permit a snug fit of the button, 2) a
size 12 Fr button is used in all cases and 3) a Tuohy needle
stabilizes the device to negotiate the tight gastric tract.
Results: The mean age at operation was 25 months (range
3 months to 13 years). The main indication for gastrostomy
was inability to swallow secondary to neurological
impairment (82%). Four patients had concommitant
laparoscopic antireflux procedure. The mean hospital stay
for gastrostomy alone was three days. The mean follow-up
was six months. There was no perioperative mortality or
major life-threatening complications associated with the
gastrostomy. No complication was serious enough to require
removal of the button or hospitalization. There were no
leaks. The nutritional status improved remarkably in the
majority of patients. Conclusions: A primary button gastrostomy can be
performed safely under laparoscopic guidance via a single
umbilical port with minimal morbidity. The use of a Tuohy
needle for the stabilization of the button facilitates the
introduction of even the smallest size of gastrostomy device.
Key words: Gastrostomy, Button, Laparoscopy, Children