Laparoscopic Assisted Percutaneous Endoscopic Gastrostomy (LAPEG): A Simple and Safe Technique of Gastrostomy Tube Placement in Patients with Failed PEG by Surgeons with Basic Laparoscopy Skills.

Alok K Gupta, MD, Alif M Manejwala, MD

Baltimore Washington Medical Center, (UMMS), Glen Burnie, MD

Percutaneous Endoscopic Gastrostomy (PEG) tube has become the most common method for gastrostomy tube placement. The standard technique is semi-blind and requires 1) visualization of the indentation in the gastric lumen on pressing the abdominal wall and 2) trans-illumination of the endoscope light on the abdominal wall.

Occasionally a PEG tube cannot be placed because of the absence of these elements or despite their presence. Even today these patients with failed PEG tube usually undergo open gastrostomy in smaller community hospitals as most surgeons consider laparoscopic gastrostomy a complex laparoscopic procedure. We present a case of a patient whom we could not place a PEG tube despite the presence of these two features.

In this patient, we successfully placed a PEG tube, using simultaneous laparoscopic and endoscopic guidance, using two 5 mm ports only. Since a routinely placed PEG tube has been established to be safe despite suture fixation of the stomach to the anterior abdominal wall, we also did not attempt placing these sutures. This allowed the procedure to be less complex, lasting a short duration only. Our patient did well post-op without any procedure related complications.

We therefore conclude that Laparoscopic Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) performed without gastric fixation sutures, is a simple and safe technique of gastrostomy tube placement in patients with failed PEG insertion and can be easily performed by surgeons with basic laparoscopy skills.

Session: Poster Presentation

Program Number: P511