ORIGINAL ARTICLE Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series Ruth Clare Wragg • Heidi Salminen • Max Pachl • Michael Singh • Anthony Lander • Ingo Jester • Dakshesh Parikh • Girish Jawaheer Accepted: 14 March 2012 / Published online: 3 April 2012 Ó Springer-Verlag 2012 Abstract Purpose To determine whether laparoscopic-assisted gastrostomy (LAG) has superseded percutaneous endo- scopic gastrostomy (PEG) based on the clinical outcomes. Methods A retrospective study was undertaken for the period January 06–December 09. Demographic and clinical outcomes were recorded and the two groups were compared. Results 164 patients were studied (PEG, n = 107; LAG, n = 57). 93.5 % of PEG patients required two general anaesthetics compared with 8 % of LAG patients. Median time to using the gastrostomy was 24 (range 0–168) h in PEG and 0 (0–96) h in LAG patients (p \ 0.001). Major complications occurred in 15/107 (14 %) of PEG and 2/57 (3.5 %) of LAG patients (p = 0.05). Re-operation rate following complications was 18/107 (16.8 %) for PEG and 3/57 (5.2 %) for LAG (p = 0.05). Minor com- plications arose in 41/107 (38 %) of PEG and 32/57 (56 %) of LAG (p = 0.05). Post-operative hospital stay was 2 (1–40) days for PEG and 2 (0–20) days for LAG (p = 0.01). The day-case rate was 0/107 for PEG and 5/57 (9 %) for LAG. There was no gastrostomy-related mortality in the series. Conclusion LAG requires fewer anaesthetics, is associ- ated with shorter time to feeding, shortened hospital stay and has a reduced risk of major complications. LAG is a very good alternative to the PEG in children. Keywords Percutaneous endoscopic gastrostomy Á Laparoscopic-assisted gastrostomy Á Child Á Outcome Á Complications Introduction Gastrostomy insertion is common in children as a result of long-term dependency upon enteral tube feeding. Introduc- tion of the percutaneous endoscopic gastrostomy (PEG) by Gauderer [1] in 1980 eliminated the need for a laparotomy in the majority of children and the technique became the gold standard. After three decades of PEG use, publication of outcome data from large case series has consistently indi- cated a significant risk of major complications [2, 3]. Several of these complications arise as a result of the blind compo- nent of the percutaneous technique. Laparoscopy offers an attractive solution to the problem by providing direct visu- alisation of all the intra-operative steps whilst retaining the advantages of the minimally invasive approach. In spite of these advantages, the use of laparoscopy for gastrostomy insertion is not widespread. The reason for this is that the evidence base in support of laparoscopy is scanty. The technique has not been subjected to a randomised controlled trial and the published reports in children have been sparse [4–6] and with inadequate follow-up. The aim of this report is to contribute to the evidence base by comparing clinical outcomes following PEG with laparoscopic-assisted gas- trostomy (LAG) in a large single centre series. Methods All patients who had a PEG or LAG between January 06 and December 09 were identified through a prospectively R. C. Wragg (&) Á H. Salminen Á M. Pachl Á M. Singh Á A. Lander Á I. Jester Á D. Parikh Á G. Jawaheer Birmingham Children’s Hospital, Birmingham, UK e-mail: r.wragg@doctors.org.uk 123 Pediatr Surg Int (2012) 28:443–448 DOI 10.1007/s00383-012-3079-5