Hassan Saif F, Pimpalwar Ashwin P
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
Pediatr Surg Int. 2011 Nov;27(11):1249-54. doi: 10.1007/s00383-011-2977-2. Epub 2011 Sep 23.
The purpose of this study was to report the outcomes of our modified LEGT technique.
Charts of 26 children who underwent modified LEGT technique between May 2008 and February 2010 were retrospectively reviewed. Their age ranged from 7 days to 16 years. Under general anesthesia, a gastroscope was placed in the stomach and laparoscopic visualization was obtained through a 5 mm umbilical port. Using laparoscopic and gastroscopic visualization, four 2'0' PDS 'T'-Fasteners were placed around a proposed gastrostomy site in the stomach. These sutures were pulled externally and tied subcutaneously so that nothing was visible outside. The gastrostomy button was then placed in the center of these four sutures at the proposed gastrostomy button site. Once the gastrostomy balloon was inflated, the four sutures were pulled taut and tied subcutaneously to pexy the stomach to the abdominal wall. Visualization with the gastroscope and laparoscope ensured proper gastrostomy button placement.
At a median follow-up of 9 months (range 10 days-2 years), none of the patients had major complications and only five had minor gastrostomy site infection which completely resolved after antibiotic therapy.
LEGT is a safe and effective technique for placement of primary G buttons/tubes in children. The laparoscopic visualization of the LEGT avoids accidental gastro-enteric fistula formation and allows primary placement of the gastrostomy button without need for subsequent procedures. LEGT ensures that the G-button is placed within the gastric lumen. Additionally, the four 'T'-Fastener technique gives optimal fixation of the stomach to the abdominal wall, avoids accidental disruption of sutures as they are placed subcutaneously and has no need for suture removal at a post-operative visit as in other techniques. Since there are no other ports used except the umbilicus this technique provides excellent cosmetic results.
本研究旨在报告改良LEGT技术的治疗结果。
回顾性分析2008年5月至2010年2月期间接受改良LEGT技术治疗的26例儿童的病历。他们的年龄从7天到16岁不等。在全身麻醉下，将胃镜置入胃内，并通过一个5毫米的脐部端口进行腹腔镜观察。利用腹腔镜和胃镜观察，在胃内拟行胃造口术部位周围放置四个2-0的PDS“T”形吻合器。将这些缝线向外牵拉并在皮下打结，使外部无可见物。然后将胃造口纽扣置于拟行胃造口纽扣部位的这四根缝线的中央。一旦胃造口气囊充气，将这四根缝线拉紧并在皮下打结，将胃固定于腹壁。通过胃镜和腹腔镜观察确保胃造口纽扣放置正确。
中位随访9个月（范围10天至2年），所有患者均无严重并发症，仅有5例发生轻微胃造口部位感染，经抗生素治疗后完全缓解。
LEGT是一种安全有效的在儿童中放置初级G纽扣/导管的技术。LEGT的腹腔镜观察可避免意外的胃肠瘘形成，并允许直接放置胃造口纽扣而无需后续操作。LEGT确保G纽扣放置在胃腔内。此外，四个“T”形吻合器技术能使胃与腹壁实现最佳固定，避免在皮下放置缝线时意外断裂，且术后复诊时无需像其他技术那样拆线。由于除脐部外未使用其他端口，该技术具有极佳的美容效果。
