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

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

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.