Sartori Alberto, De Luca Maurizio, Lunardi Cesare, Clemente Nicola, Segato Gianni, Rossi GianMaria, De Luca Alberto, Minni Massimo, Colaut Flavio, Fortunato Costanzo, Nicolì Francesco, Castiglioni Cristina, Pellicanò Natale, Scaffidi Guido, De Marchi Francesco
1 Department of General Surgery, San Valentino Hospital , Montebelluna, Treviso, Italy .
2 Department of Surgery, Regional Hospital of Vicenza , Vicenza, Italy .
J Laparoendosc Adv Surg Tech A. 2018 Oct;28(10):1192-1195. doi: 10.1089/lap.2018.0119. Epub 2018 Jun 20.
Since its introduction, the placement of percutaneous endoscopic gastrostomy (PEG) has been increasing in the Western countries. Nevertheless, it is not always possible to perform this operation. Laparoscopic-assisted endoscopic gastrostomy (LAPEG) is an effective alternative solution.
Indication to PEG placement was established only for people who required a nutritional support of >4 weeks and without metastatic carcinoma. Sixteen patients underwent LAPEG after the failure of the original PEG operation. Two trocars of 5 mm and one of 12 mm were used, and a fourth trocar of 5 mm was placed when necessary to lift the liver. In four cases a gastrotomy was performed, in seven patients it was not necessary. When PEG was placed, the stomach was not fixed with stitches to the abdominal wall.
Sixteen patients were selected for LAPEG and were all successful; in one case it was necessary to replace the PEG, and the same procedure was performed again. Median age was 73 years. Placement of laparoscopic PEG was not associated with other surgical procedures. Nutritional feeding started the day after for patients with sutureless technique and 2 days after in patients with gastrotomy.
LAPEG is a safe technique with a low complication rate. It should be considered a minimal alternative in all cases where the placement of PEG is not possible.
自经皮内镜下胃造口术（PEG）引入以来，其在西方国家的应用一直在增加。然而，并非总能进行该手术。腹腔镜辅助内镜下胃造口术（LAPEG）是一种有效的替代解决方案。
仅对需要超过4周营养支持且无转移性癌的患者确定PEG置入指征。16例患者在原PEG手术失败后接受了LAPEG。使用了两个5毫米的套管针和一个12毫米的套管针，必要时放置第四个5毫米的套管针以抬起肝脏。4例进行了胃切开术，7例患者无需进行。放置PEG时，胃未用缝线固定于腹壁。
16例患者被选行LAPEG且全部成功；1例需要更换PEG，并再次进行相同手术。中位年龄为73岁。腹腔镜PEG置入与其他外科手术无关。无缝线技术的患者术后第一天开始营养喂养，胃切开术的患者术后第二天开始。
LAPEG是一种安全的技术，并发症发生率低。在所有无法进行PEG置入的情况下，应将其视为一种最小限度的替代方法。
