IS LAPAROSCOPICALLY ASSISTED PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SUPERIOR TO STANDARD PEG PLACEMENT?

Objectives: Percutaneous Endoscopic Gastrostomy (PEG) tube placement is often required in patients with dysphagia following traumatic brain injury or stroke (CVA). There has been little change to the procedure since it was first described in 1980, although the addition of laparoscopy has been proposed as an adjunct to reduce complications. However, it remains unclear whether laparoscopically assisted percutaneous endoscopic gastrostomy (LAPEG) tube placement is superior to standard PEG placement. We hypothesized that the LAPEG technique reduces major complications when compared to standard PEG.

Methods: We performed a retrospective analysis of all gastrostomy tubes placed by the acute care surgery service at our level I trauma center database from May 2019 to December 2021 using either technique. All adult patients were included if they had complete data. The primary outcome measure was major complication. Secondary outcome measures included minor complications, time in OR, and mortality. Chi squared testing was used for statistical comparisons between groups and t-testing was used for continuous variables (IBM SPSS Statistics v28).

Results: 413 patients were identified for analysis; 265 males and 148 females. There were 50 patients who underwent LAPEG, and 363 who underwent standard PEG placement. 99% of all procedures were done in the operating room. Only 5 patients required conversion to open, all in the PEG group. Patients who underwent PEG had a higher rate of major complications compared to LAPEG; 5.2% vs. 0%, although this was not statistically significant (P = NS). The minor complication rate was also lower, but again not statistically different. OR time was significantly longer with LAPEG vs. PEG (38 minutes vs. 25 minutes, P< 0.05). Overall in-hospital mortality was 21%, higher in the PEG group - 22.6% vs. 10% (P < 0.05). Bumper height was not different between LAPEG and PEG (3cm, P = NS) and there was no association with complication rates.

Conclusion: LAPEG was associated with a trend towards decreased major complication rates compared to standard PEG. This was at the cost of an increase in operative time. Further research should focus on a cost benefit analysis of LAPEG versus PEG to evaluate if the increase in time and cost of disposables is offset by the decreased costs of fewer complications.