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Percutaneous laparoscopic assisted gastrostomy (PLAG)—a new technique for cases of pharyngoesophageal obstruction

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Abstract

Purpose

Percutaneous endoscopic gastrostomy (PEG) is the preferable method to provide enteral nutrition for a longer time period. Safe placement of a PEG tube requires passage of the esophagus and transillumination of the stomach through the abdominal wall. Surgical placement of a PEG tube has been shown to be feasible although the local complication rate ranges above the endoscopic procedure. We are presenting a new technique (percutaneous laparoscopically assisted gastrostomy, PLAG) to provide enteral access for patients with pharyngoesophageal obstruction not suitable for PEG placement.

Methods

We have developed a laparoscopic method that allows full control of the stoma location at the anterior gastric wall. The tube has a deployable bumper mechanism, which can be inserted through a minimal gastric incision. Combined with the fixation by transcutaneous sutures, the risk for leakage or dislodgement is low.

Results

Fifty-one PLAGs were inserted in 45 male and six female patients suffering from pharyngoesophageal obstruction due to malignancy. Patients were referred after unsuccessful endoscopic PEG placement (n = 39) or received their PLAG when they underwent staging laparoscopy (n = 12). Success rate was 96.2%. No procedure-related mortality was observed. Infectious complications occurred in three (5.9%) cases. In five patients, minor leaks were managed conservatively (n = 4) or required relaparoscopy (n = 1) and placement of an additional suture (overall complication rate of 15.8%, n = 8). Nutritional goals were reached after 7.8 ± 2.3 days.

Conclusion

PLAG is a safe and easy procedure. It can well be used to provide enteral access for patients with pharyngoesophageal obstruction not suitable for endoscopic PEG placement.

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Author notes

  1. Ulrich Bolder

    Present address: Department of Surgery, St.-Johannes-Hospital, 44137, Dortmund, Germany

  2. Peter Vogel

    Present address: Department of Surgery, Allgemeines Krankenhaus, 29223, Celle, Germany

Authors and Affiliations

  1. Department of Surgery, University Hospital, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Ulrich Bolder, Marcus N. Scherer, Thorsten Schmidt, Matthias Hornung, Hans-Jürgen Schlitt & Peter Vogel

Authors
  1. Ulrich Bolder
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  2. Marcus N. Scherer
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  3. Thorsten Schmidt
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Corresponding authors

Correspondence to Ulrich Bolder or Marcus N. Scherer.

Additional information

Ulrich Bolder and Marcus N. Scherer contributed equally to this work.

Contributions of each author

Ulrich Bolder: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript

Marcus N. Scherer: study design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript

Thorsten Schmidt: acquisition of data, analysis and interpretation of data, drafting of manuscript

Matthias Hornung: analysis and interpretation of data, drafting of manuscript

Hans-Jürgen Schlitt: critical revision of manuscript

Peter Vogel: analysis and interpretation of data, drafting of manuscript, critical revision of manuscript

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Bolder, U., Scherer, M.N., Schmidt, T. et al. Percutaneous laparoscopic assisted gastrostomy (PLAG)—a new technique for cases of pharyngoesophageal obstruction. Langenbecks Arch Surg 395, 1107–1113 (2010). https://doi.org/10.1007/s00423-010-0612-7

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  • DOI: https://doi.org/10.1007/s00423-010-0612-7

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