Laparoscopic technique to perform a true Stamm gastrostomy in children

Abstract Purpose A surgical gastrostomy is mandatory in cases where a PEG is not feasible. Various minimally invasive techniques have been described, but many involve unusable materials in small children and/or have risk of disunion. We describe a technique for true Stamm gastrostomy performed by la...

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Bibliographic Details
Published in:Journal of pediatric surgery 2015-10, Vol.50 (10), p.1797-1800
Main Authors: Vasseur Maurer, Sabine, Reinberg, Olivier
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Enteral Nutrition
Fundoplication
Gastrostomy
Gastrostomy - adverse effects
Gastrostomy - instrumentation
Gastrostomy - methods
Granuloma - etiology
Humans
Infant
Laparoscopy
Laparoscopy - adverse effects
Laparoscopy - instrumentation
Laparoscopy - methods
Length of Stay
Necrosis - etiology
Pediatrics
Stamm
Stomach - pathology
Stomach Diseases - etiology
Surgery
Suture Techniques
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Summary:Abstract Purpose A surgical gastrostomy is mandatory in cases where a PEG is not feasible. Various minimally invasive techniques have been described, but many involve unusable materials in small children and/or have risk of disunion. We describe a technique for true Stamm gastrostomy performed by laparoscopy (LSG) with a purse string suture and four points of attachment onto the wall. Method We reviewed 20 children who underwent an LSG from 2010 to 2013. After incision of the skin at the location planned for the gastrostomy, using three 3-5 mm ports the stomach is fixed to the wall by three suspension stitches, which are entered and then emerged subcutaneously. A fourth stitch of attachment is used to make an award on the stomach and tie around the gastrostomy tube. Results Mean age was 4.2 years, with 70% aged < 2 years. All children were malnourished, most often severely. All but two underwent a concomitant fundoplication. Feeding through the gastrostomy started on D0 or D1. Total feeding by gastrostomy was achieved in a mean duration of 2.9 day. Mean hospital stay was 4.5 days. There was no perioperative complication. Mean follow-up was 14 months. Once, the balloon was accidently deflated and reinflated in the wall leading to its necrosis. Five peristomial granulomas were noticed. It was always possible to replace the tube by a gastrostomy device at least 6 weeks after surgery. Conclusion This new technique for true Stamm gastrostomy by laparoscopy reproduces exactly the one done by laparotomy, without special equipment. It can be made since the neonatal period, in all the circumstances when a laparoscopy is possible.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2015.06.010