Laparoscopic Gastrostomy in Children: 10 Years of Experience

Objectives: Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy.
Methods: The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse–string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally.
Results: There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day–18 years), and the average body weight was 13 kg (2300 gr–65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate.
Conclusion: The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.

Çocuklarda laparoskopik gastrostomi uygulamasý: On yýllýk deneyim

Giriþ: Laparoskopik gastrostomi, beslenme bozukluklarý, nörolojik hastalýðý veya büyüme geliþme geriliði olan çocuklarda yaygýn olarak kullanýlan bir prosedürdür. Gastrostomi tüpü takýlmasý uygulama tekniðine göre farklý yöntemlerle gerçekleþtirilebilir. Laparoskopik trokar yerinden yapýlan primer gastrostomi, özel enstrümantasyon ve kit gerektirmeyen basit ve kolay bir tekniktir. Bu çalýþmada, 10 yýllýk gastrostomi deneyimlerinin sunulmasý amaçlanmýþtýr.
Yöntem ve Gereçler: 2006-2016 yýllarý arasýnda laparoskopik gastrostomi uygulanan 128 çocuðun verileri geriye dönük olarak incelendi. Demografik bilgiler, operatif iþlemler ve komplikasyonlar da dahil olmak üzere veriler kaydedildi. Tüm çocuklara preoperatif kontrastlý görüntüleme ve 24 saatlik Ph monitörizasyonu uygulandý. Tüm hastalara trokar giriþ yerinden primer gastrostomi yapýldý. Mide laparoskopik olarak trokar yerinden çekildi, mideden pursestring bir dikiþ geçilerek mide rektus kasýnýn anterioruna ekstrakorporeal olarak sabitlendi ve gastrostomi tüpü veya butonu yerleþtiridi.
Bulgular: 49 kýz (% 38,3) ve 79 erkek (% 61,7) çocuk vardý. Cerrahi öncesi süre (1 gün-18 yýl) ortalama yaþ 50 aydý ve ortalama vücut aðýrlýðý 13 kg (2300 gr-65 kg) idi. 116 (% 90,6) çocuða hem laparoskopik Nissen fundoplikasyonu hem gastrostomi; 12 hastada (% 9,4) sadece laparoskopik gastrostomi uygulandý. En sýk görülen komplikasyon antibiyotik ile tedavi edilen gastrostomi alaný enfeksiyonuydu (n=14). 9 (% 7) hastada 30 gün içinde periton kaçaðý görüldü. 5 çocukta gastrostomi tüpünün çýkmasý nedeni ile ameliyat gerekti. 4 çocukta gastrostomi çevresinde granülom geliþti, gümüþ nitrat ile yakýlarak tedavi edildi.
Sonuç: Trokar giriþ yerinden yapýlan primer laparoskopik gastrostomi, komplikasyon oranlarýnýn diðer laparoskopik gastrostomi yöntemleriyle karþýlaþtýrýlabilir olduðu, güvenli ve kolay bir yöntemdir.