The endoscopic U-stitch technique for primary button placement: an institution's experience.

BACKGROUND: Various gastrostomy tube placement techniques have been reported in the literature. The endoscopic U-stitch technique allows for primary button placement without the need for laparoscopy. The purpose of this study was to quantify the completion rate and the occurrence of complications with this procedure at one academic teaching hospital. METHODS: All gastrostomy procedures between February 2001 and September 2008 were reviewed. Data were collected from paper and electronic records for endoscopic U-stitch procedures. RESULTS: Endoscopic U-stitch gastrostomies were attempted in 121 patients, with primary button placement in 115 (95%) and conversion to an open procedure in 6. No procedure-related deaths occurred, and 7% of patients experienced postoperative complications that included hematemesis, cellulitis, colonic perforation, granulation tissue requiring operative excision, and surgical fistula closure. Average operative time was 18 min. CONCLUSION: The endoscopic U-stitch technique is safe and allows for primary button placement in infants and children. Its complication rate compares favorably with other laparoscopic and open techniques described in the literature.

Early experience with single-port laparoscopic surgery in children.

INTRODUCTION: The current paradigm in laparoscopic surgery is for each instrument to enter the abdomen through its own separate incision. The advent of newer laparoscopic trocars and instruments now allows for all instruments to enter through a single incision. This may lead to less pain and improved cosmetic outcome. Single-incision laparoscopic surgery (SILS) has recently been described in adults. In this article, we report our preliminary experience of SILS in children. METHODS: A retrospective review was performed of the operative database at Rainbow Babies and Children's Hospital (Cleveland, OH) from March 2008 to March 2009, looking for all cases that were performed through a single laparoscopic incision. RESULTS: A total of 72 SILS cases were performed. These included cholecystectomy, splenectomy, intussusception reduction, gastrostomy tube placement, thoracoscopic lung biopsy, thoracoscopic decortication, and appendectomy. Five appendectomies were converted to traditional three-port laparoscopy. There were two umbilical wound infections after an appendectomy. There were no other complications. CONCLUSION: Preliminary experience with SILS in children appears to be safe and effective. Greater numbers and a prospective trial will be necessary to assess the true benefit of this approach.

Short-term natural history of the standard approaches for gastrostomy tube placement in the pediatric patient.

INTRODUCTION: Gastrostomy placement is a common procedure in the pediatric population. Standard approaches of tube placement include open, laparoscopic, and percutaneous endoscopic methods. Placement of the gastrostomy in relation to the fundus and the anterior abdominal wall is crucial to ensure adequate comfort and functionality. Misplacement may require repositioning of the gastrostomy, the rate of which has not been well documented. We, therefore, have reviewed a multi-institutional experience with gastrostomy tube placement to determine the short-term natural history of placement, based on approach, and to establish a cohort to determine the long-term natural history. METHODS: We conducted a retrospective review of all pediatric patients who underwent percutaneous endoscopic, laparoscopic, or open gastrostomy placement at two institutions from 2000 to 2008. RESULTS: There were a total of 1534 patients who underwent gastrostomy tube placement during this time period. The most common procedure was fundoplication with gastrostomy (N = 832), followed by gastrostomy alone (N = 420), and then percutaneous endoscopic gastrostomy (PEG) (N = 285). There were 4 (0.3%) gastrostomy tubes that required repositioning to a new site due to encroachment upon the rib margin. Two were open and 2 were PEG (P > 0.99). Twenty of 39 patients who had an open fundoplication following gastrostomy had the gastrostomy taken down during the procedure, compared to 5 of 31 patients (P = 0.03), who underwent laparoscopic fundoplication following gastrostomy. CONCLUSIONS: These data demonstrate that the need for gastrostomy tube repositioning is rare in the short term, regardless of approach, although a takedown of the gastrostomy is more likely when an open fundoplication is performed.