Evaluation of Laparoscopy-Assisted Percutaneous Gastrostomy Tube Placement in Children
AbstractPurpose: To evaluate the safety, efficacy, and results of laparoscopically assisted placement of gastrostomy tubes (LAPGT) and compare the cost with that of percutaneous endoscopic gastrostomy (PEG). Patients and Methods: The medical records of all patients who underwent laparoscopic gastrostomy tube placement (N = 51) either alone (N = 8) or in conjunction with a fundoplication (N = 43) over a 2-year period (1998-1999) were evaluated for complications, length of procedure, and hospital charges. Hospital charges were compared with those of eight randomly selected patients who underwent PEG during the same period. We also reviewed the PEG database over this period to evaluate the percentage of children requiring a second procedure to convert a gastrostomy tube to a low-profile device. Results: There were no major complications related to gastrostomy tube placement in any of the 51 patients who underwent LAPGT. The operative time for LAPGT alone was 45 minutes. The initial hospital charges for LAPGT was $1050 more than for placement of a PEG. The difference was mainly related to operative time. Thirteen percent of all patients who underwent PEG required a second operation for revision to a low-profile device. Conclusion: The LAPGT is a safe alternative to other methods of gastrostomy tube placement. The initial hospital charges for LAPGT are approximately $1050 more than for PEG because of the longer operative time. However, further analysis is needed to compare overall expenses including need for reoperation and treatment of complications.