Laparoscopic-assisted percutaneous endoscopic gastrostomy in two patients who failed percutaneous endoscopic gastrostomy

Ziad Abbassi; Surennaidoo P Naiken; Nicolas C Buchs; Wojciech Staszewicz; Emiliano Giostra; Philippe Morel

doi:10.1016/j.ijscr.2015.06.002

Laparoscopic-assisted percutaneous endoscopic gastrostomy in two patients who failed percutaneous endoscopic gastrostomy

Int J Surg Case Rep. 2015:13:40-2. doi: 10.1016/j.ijscr.2015.06.002. Epub 2015 Jun 6.

Authors

Ziad Abbassi¹, Surennaidoo P Naiken², Nicolas C Buchs², Wojciech Staszewicz², Emiliano Giostra³, Philippe Morel²

Affiliations

¹ Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland. Electronic address: Ziad.abbassi@hcuge.ch.
² Clinic for Visceral and Transplantation Surgery, Departments of Surgery, University Hospital of Geneva, Geneva, Switzerland.
³ Division of Gastroenterology, University Hospital of Geneva, Geneva, Switzerland.

Abstract

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a common procedure to obtain a feeding tube. However, this technique might imply several difficulties and complications. The inability to transilluminate the abdominal wall may occur frequently, especially in obese or multi-operated patients. With the emergence of minimally invasive surgery, laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) might provide a safe and efficient alternative.

Presentation of cases: We report hereby two cases of patients having undergone LAPEG in our institution. Conventional PEGs were deemed impossible because of the absence of transillumination and motivated a surgical approach. Two obese patients with a Body Mass Index (BMI) of 31 and 45kg/m(2) respectively presented neurological condition (stroke and Parkinson's disease) requiring a feeding tube. While a PEG was unsuccessful (impossibility to transilluminate), a LAPEG was attempted. The procedure and the recovery were uneventful.

Discussion: There are different techniques for gastrostomy tube placement: open gastrostomy, PEG and radiologic procedure. The PEG is associated with a significant risk of bowel perforation. LAPEG seems to be an interesting option in order to avoid an open gastrostomy in patients in whom a PEG cannot be performed. This is especially true in obese patients, where a transillumination cannot be performed. It offers an endoscopic view of the stomach simultaneously to the laparoscopic approach that allows a potential decrease of major complications.

Conclusion: While the literature reports mainly pediatric cases, we present herein two successful LAPEG in adult obese patients. In case of impossibility to perform PEG, this technique allows a safe direct visualization of the stomach and other adjacent organs.

Keywords: Gastroscopy; Gastrostomy; Laparoscopy; PEG.