Guanà Riccardo, Garofalo Salvatore, Lonati Luca, Teruzzi Elisabetta, Cisarò Fabio, Gennari Fabrizio
Department of Pediatric General Surgery, Regina Margherita Children's Hospital, University Hospital of Health and Science, Turin, Italy.
J Laparoendosc Adv Surg Tech A. 2020 Feb;30(2):216-220. doi: 10.1089/lap.2019.0517. Epub 2019 Nov 19.
Gastrostomy tube placement (G-Tube) is a frequently offered procedure in children with feeding difficulties. Various procedures exist for G-Tube, with the pull technique more commonly used for a percutaneous endoscopic gastrostomy (PEG) in children, considered by many to be the safer approach. Major complications requiring reoperation range from 3% to 5%, depending on the study. In our center, PEG placement is performed by gastrointestinal endoscopists through the pull technique. In the last 5 years, there were 150 procedures, with 15 minor and 3 major complications. We will describe the last 3 cases, plus a fourth PEG placement at another center. Patients ranged from 2 to 10 years (median age: 4.5 years). Median weight was 10.7 kg (range: 7-18 kg). Patients were neurologically impaired children, except one with severe nephropathy. Laparoscopic repair with a 3-trocar technique was effective, when the patient's general condition allowed for it. After fistula repair, a new gastrostomy was placed; this step can be performed endoscopically under laparoscopic control (or can be performed completely laparoscopically). In 4 patients, we faced unusual PEG placement complications, due to colon interposition during blind gastric puncture. In those with anatomical deformities or previous surgery, or dealing with toddlers (under 10 kg), we suggest laparoscopic-assisted PEG, or a full laparoscopic gastrostomy to avoid the risk of a major complication.
胃造口管置入术（G管）是针对有喂养困难的儿童经常实施的一种手术。胃造口管有多种置入方法，其中牵拉技术在儿童经皮内镜下胃造口术（PEG）中更为常用，许多人认为这是更安全的方法。根据不同研究，需要再次手术的主要并发症发生率在3%至5%之间。在我们中心，PEG置入术由胃肠内镜医师通过牵拉技术进行。在过去5年中，共进行了150例手术，出现了15例 minor并发症和3例主要并发症。我们将描述最后3例病例，以及在另一个中心进行的第四例PEG置入术。患者年龄在2至10岁之间（中位年龄：4.5岁）。中位体重为10.7千克（范围：7至18千克）。除1例患有严重肾病外，患者均为神经功能受损儿童。当患者一般状况允许时，采用三套管技术进行腹腔镜修补术是有效的。在瘘管修补后，置入新的胃造口管；这一步骤可在腹腔镜控制下通过内镜进行（或完全通过腹腔镜进行）。在4例患者中，由于盲目胃穿刺时结肠介入，我们遇到了不寻常的PEG置入并发症。对于有解剖畸形或既往手术史的患者，或处理幼儿（体重低于10千克）时，我们建议采用腹腔镜辅助PEG或完全腹腔镜胃造口术，以避免发生主要并发症的风险。
