Abstract
Introduction:
Gastrojejunostomy (GJ) tubes are an option for durable enteral access for critically ill infants with congenital cardiac disease who struggle with obtaining adequate nutrition. We illustrate the method of laparoscopic placement of modified GJ tubes in which a nasojejunal feeding tube is threaded through a standard low-profile gastrostomy tube button.
Methods:
Infants less than 10 kg with cardiac disease who received placement of a laparoscopic GJ tube from November 2011 to January 2015 were reviewed. The operative technique utilized an umbilical port for the camera and a single stab incision for the gastric access site. After insufflation to 5 to 8 mm Hg, the stomach was suspended to the abdominal wall, after which a dilator was maneuvered into a post-pyloric position using laparoscopic visualization and fluoroscopy, and a glidewire was passed into the duodenum. The GJ tube was then fluoroscopically threaded over the glidewire; the final position was confirmed by contrast injection.
Results:
A total of 32 laparoscopic GJ tube placement operations were performed; 7 (21.9%) of these tubes were standard single-unit GJ tubes and 25 (78.1%) were low-profile gastrostomy tubes modified with a nasojejunal feeding tube threaded through the feeding port. The median patient age was 3.5 months (range 0.75–11 months), with median weight of 4.2 (2.4–7.4) kg. Congenital defects varied, including hypoplastic left heart syndrome and pulmonary vein stenosis. The median operative time was 62 minutes (range 35–114 minutes) for isolated GJ placement. There were three postoperative complications resulting in a 30-day complication rate of 9.4%. Thirty-day mortality was 9.4% with no mortality related to the operation.
Conclusion:
Laparoscopic GJ tube placement may be performed safely in infants with cardiac disease and allows these patients to receive adequate nutrition despite intolerance of gastric feeding.
Presented in part at the International Pediatric Endosurgery Group 24th Annual Congress in Nashville, Tennessee; Accompanying manuscript submitted to Journal of Laparoendoscopic & Advanced Surgical Techniques (Manuscript ID LAP-2015-0118).
No competing financial interests exist.
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