Villalona Gustavo A, Mckee Milissa A, Diefenbach Karen A
Section of Pediatric Surgery, Yale University School of Medicine, Yale-New Haven Children Hospital, New Haven, Connecticut 06520, USA.
J Laparoendosc Adv Surg Tech A. 2011 May;21(4):355-9. doi: 10.1089/lap.2010.0201. Epub 2011 Mar 28.
To describe a modification in the Georgeson technique for laparoscopic gastrostomy tube (LGT) placement and compare the rate of reoperation for disruption of the gastrostomy tract after LGT by our modified technique to our own series of percutaneous endoscopic gastrostomy (PEG) tubes as well as the published rates of reoperation for LGTs and PEGs.
In 2003, we modified our technique for LGT to include laparoscopically placed sutures to secure the stomach to the abdominal wall. A retrospective review was performed on all children undergoing LGT placement and PEGs from March 2003 to October 2009. In addition, a review of the literature was performed to identify the published rates of complications for these procedures.
During this time period, we have performed 85 LGT using this modified technique. In that same period, there have been 34 PEGs placed. The modification in our technique was instituted after a patient required reoperation for dislodgement in a laparoscopic U-stitch gastrostomy. To date, in the modified LGT group, there have been no disruptions of the gastrostomy tract in either the early or late periods, <90 days or >90 days, respectively. There have been 5 (5.9%) early dislodgements of the gastrostomy tube. All of these were before postoperative day 14 (at postoperative days 1, 2, 6, and 12), and all were replaced with placement verified by contrast study. None required reoperation. In the PEG group, there was 1 (2.9%) early and 1 (2.9%) late dislodgements and tract disruption that required reoperation. The published rate of dislodgement requiring reoperation in the Georgeson series of LGTs is 2.6%. The published rate of reoperation for dislodgement in PEGs is 4%-6%.
This modification of the Georgeson technique has been successful in reducing the need for reoperation associated with gastrostomy replacement after dislodgement.
描述乔治森技术在腹腔镜胃造口管（LGT）置入术中的一种改良方法，并将采用我们改良技术置入LGT后胃造口道破裂的再次手术率与我们自己的经皮内镜胃造口术（PEG）系列以及已发表的LGT和PEG的再次手术率进行比较。
2003年，我们对LGT技术进行了改良，包括在腹腔镜下放置缝线以将胃固定于腹壁。对2003年3月至2009年10月期间所有接受LGT置入术和PEG的儿童进行了回顾性研究。此外，对文献进行了回顾以确定这些手术已发表的并发症发生率。
在此期间，我们使用这种改良技术进行了85例LGT。同一时期，共置入了34根PEG。在一名腹腔镜U形缝合法胃造口术患者因移位需要再次手术之后，我们对技术进行了改良。迄今为止，在改良LGT组中，无论是早期（<90天）还是晚期（>90天），均未出现胃造口道破裂。胃造口管有5例（5.9%）早期移位。所有这些均发生在术后第14天之前（术后第1、2、6和12天），并且均通过造影检查证实位置正确后重新进行了放置。无一例需要再次手术。在PEG组中，有1例（2.9%）早期和1例（2.9%）晚期移位以及造口道破裂需要再次手术。乔治森系列LGT中已发表的需要再次手术的移位发生率为2.6%。PEG中因移位而再次手术的已发表发生率为4%-6%。
乔治森技术的这种改良成功地减少了移位后胃造口置换相关的再次手术需求。
