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Laparoscopic-assisted Stamm-gastrostomy: technical modifications to ease suturing inside the minimal trocar site

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Abstract

Laparoscopic gastrostomy tube placement has been increasingly adopted by pediatric surgeons. We herein report our experience with the performance of a laparoscopic-assisted Stamm-operation inside the minimal trocar site without the extension of the trocar site incision or mini-laparotomy. We present some technical modifications that facilitate suturing inside the minimal trocar site.

Methods

A retrospective chart review was conducted of cases involving patients who underwent laparoscopic-assisted gastrostomy, using a simple extracorporeal method inside the trocar site from April 1998 to March 2018.

Results

One hundred five gastrostomy tubes were placed in a laparoscopic-assisted operation. All but two of the cases involved patients with neurological impairment. The mean age was 12.5 years; 28 cases were > 16 years of age. Seventy-five cases underwent gastrostomy during laparoscopic fundoplication. All gastrostomy procedures were completed without intraoperative difficulties; however, 8 cases, which involved a thick abdominal wall, required extension of the trocar site. No cases required conversion to open gastrostomy. No major complications were observed. Two patients developed continuous peristomal cellulitis after surgery, due to the mismatch of the site position and an unsuitable button device size.

Conclusion

We demonstrated that laparoscopic gastrostomy with fully extracorporeal suturing within the trocar site is feasible and beneficial, especially for the most neurologically impaired pediatric cases. Technical modification, changing the order of the process, and suturing technique in the minimal space, made it easier to perform the procedures inside the minimal trocar hole.

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Authors and Affiliations

  1. Department of General Thoracic, Breast, Pediatric Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan

    Ryuichiro Hirose, Takeshi Shirai, Kaori Inatomi, Yusuke Yanagi, Tsuyoshi Iwanaka, Minori Ishii & Akinori Iwasaki

  2. Department of Pediatrics, Faculty of Medicine, Saga University, 5-1-1 Nabeshima Saga-shi, Saga, 840-8502, Japan

    Takaharu Yamada

  3. Pediatric Surgery, Aso Iizuka Hospital, 3-83, Yoshio, Iizuka-shi, Fukuoka, 820-8505, Japan

    Masatoshi Nakamura

  4. Pediatric Surgery, National Hospital Organization Kyushu Medical Center Hospital, 1-8-1 Jigyo-hama, Chuo-ku, Fukuoka, 810-8563, Japan

    Hiroki Kai

Authors
  1. Ryuichiro Hirose
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  2. Takeshi Shirai
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  3. Takaharu Yamada
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  4. Masatoshi Nakamura
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  5. Hiroki Kai
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  6. Kaori Inatomi
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  7. Yusuke Yanagi
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  8. Tsuyoshi Iwanaka
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  9. Minori Ishii
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  10. Akinori Iwasaki
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Corresponding author

Correspondence to Ryuichiro Hirose.

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Laparoscopy-assisted Stamm-gastrostomy in an infant case. (MPG 65858 kb)

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Hirose, R., Shirai, T., Yamada, T. et al. Laparoscopic-assisted Stamm-gastrostomy: technical modifications to ease suturing inside the minimal trocar site. Surg Today 50, 783–786 (2020). https://doi.org/10.1007/s00595-019-01914-6

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  • DOI: https://doi.org/10.1007/s00595-019-01914-6

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