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Laparoscopic‐Assisted Percutaneous Endoscopic Gastrostomy
Author(s) -
Shimizu Yoshiyuki,
Okuyama Hiroomi,
Sasaki Takashi,
Nose Satoko,
Saka Ryuta
Publication year - 2014
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607113481476
Subject(s) - medicine , percutaneous endoscopic gastrostomy , gastrostomy , surgery , stomach , catheter , endoscope , enteral administration , parenteral nutrition , peg ratio , finance , economics
Background/Purpose : Percutaneous endoscopic gastrostomy (PEG) is a simplified catheter placement procedure for alimentation. Although the endoscopic approach to gastrostomy tube placement is a safe and well‐tolerated procedure in most patients, the PEG procedure is difficult in elderly patients disabled since childhood who have severe scoliosis and malpositioning of the stomach. We describe a simple and effective laparoscopic‐assisted PEG (LAPEG) technique that can be used for catheter placement in severely disabled patients. Methods : Thirteen severely disabled patients aged 14–57 years underwent gastrostomy tube placement with the LAPEG technique. After general anesthesia was achieved, an endoscope was placed into the stomach. Then, a 5‐mm camera port was inserted at the umbilicus, and a 3‐mm working port was inserted to identify and lift the optimal site for gastrostomy tube placement. After the 4‐point fixation of the stomach, the 20‐Fr gastrostomy tube was placed under endoscopic and laparoscopic observation. Results : All patients tolerated the procedure well, and there were no major complications. The procedure was successful, and all patients could feed via the tube. Conclusions : Elderly disabled patients who have been bedridden since childhood often have severe scoliosis and malpositioning of the stomach. Our LAPEG procedure is effective, well tolerated, and safe for gastrostomy tube placement in such elderly patients.