부산대학교 도서관

Aim: Various laparoscopic techniques including use of stay stitches plus purse string, trans-parietal sutures, Stamm sutures via abdominal gastrostomy site incision for gastric wall fixation have been reported. We report our low cost, safe and very reliable technique, and its comparison with others.Methods: The medical records of 80 children who had primary laparoscopic balloon gastrostomy (PLBG) performed between 2001 and 2018 were reviewed. The mean age: 30 months (1 month–15 years 10 months). Gastrostomy site was planned and under laparoscopic visualization, two temporary U-stitches were placed across the anterior stomach wall at the planned gastrostomy site. Our assembled kit for the Seldinger technique included a 12-gauge intravenous cannula, guide wire, dilator size 12/14/16 Fr and an anaesthetic spinal Tuohy needle. A 12 Fr Button with the length matching the thickness of the abdominal was used.Results: There was no perioperative mortality or major complications. Feeding via the gastrostomy 3 h postoperatively associated with no leaks. Late minor complications such infection or gastrostomy site granulation were easily treated in the community. Regular change of the gastrostomy button was carried out by the Community team. One patient had a persistent leak after removal of un-used button required an excision of tract and closure (1.25%). Literature review of other techniques for PLBG and gastroscopy guided primary button gastrostomy, complications reported were mainly minor, major ones ranged from 0% to 1%.Conclusions: Primary laparoscopic button gastrostomy is safe, feasible and reliable among reported series and the technique of gastric fixation is more of an individual preference.