Nir Hus Md., Phd., Daud Lodin, MD, Anupam K Gupta. FAU
Introduction: Gastroscopic assisted percutaneous endoscopic gastrostomy (PEG) is an easy means to provide enteral access in patient unable to intake nutrition via oral route. However, in many patients with unfavorable body habitus secondary to prior abdominal surgery, interpositioning of the colon between the stomach and anterior abdominal wall, laparoscopic means can allow this procedure to be performed safely. In this particular patient population, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) can provide an alternative route for enteral access.
Methods: This is a retrospective case-series of patients, who underwent LAPEG placement. Inclusion into our study involved patients who were unable to undergo Gastroscopic assisted PEG due to abnormal body habitus, previous abdominal procedures, or unfavorable anatomy. Patients were placed under general anesthesia and a 5 millimeter video port was inserted at the level of the umbilicus. Patients were placed in steep reverse Trendelenburg position to mobilize the colon away from the stomach. In some patients, we were required to place a single additional 5 millimeter port to complete lysis of adhesions and to facilitate a window for stomach opposition to abdominal wall. Intra-abdominal pneumoperitoneum pressures were reduced and a gastroscope was introduced. Stomach was insufflated via gastroscopy and brought close to the anterior abdominal wall. A needle was introduced into the stomach percutaneously, while ensuring no damage to the surrounding structures. The needle was visualized via gastroscope and a guidewire was introduced and brought out through the oral cavity. The gastrostomy tube was passed over the guidewire into the stomach using the Seldinger technique and the approximation was again confirmed via laparoscopic and gastroscopic views. The trocar ports were closed only with skin sutures. Their new gastrostomy tubes were immediately put to use post-operatively with a test administration of clear liquids and medications.
Results: 24 patients met our inclusion criteria. There were 18 males (75 percent) and 6 females (25 percent) with a mean age group of 75 and a mean body mass index of 22 . We were required to place an additional 5 mm port in 4 (17 percent) patients. We were able to successfully place gastrostomy tubes in all our patients and all were found patent and functional after immediate postoperative administration of liquids and medications. No postoperative complications resulted from this procedure.
Discussion: LAPEG is a safe and effective method to provide enteral access in patients, who are unable to receive gastroscopic assisted PEG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93368
Program Number: P486
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster