# Feasibility of Laparoscopically Assisted Percutaneous Endoscopic Gastrostomy in Patients for Whom Endoscopic Gastrostomy Is Difficult: A Retrospective Study

## TL;DR

This study compares a new minimally invasive surgical technique (LAPEG) with traditional open surgery for patients who cannot undergo standard gastrostomy procedures.

## Contribution

The study evaluates the feasibility of laparoscopically assisted gastrostomy as an alternative to open surgery in challenging cases.

## Key findings

- LAPEG and open gastrostomy had similar median operative times and blood loss.
- No significant differences in surgical outcomes were found between the two techniques.
- LAPEG is a viable alternative to open surgery for difficult gastrostomy cases.

## Abstract

Background

Percutaneous endoscopic gastrostomy is a widely used technique for long-term enteral nutrition. However, some patients have anatomical or pathological conditions making standard percutaneous endoscopic gastrostomy infeasible. Traditionally, open gastrostomy (Open-G) has been performed in these cases, although it is more invasive.

Laparoscopically assisted percutaneous endoscopic gastrostomy (LAPEG) has recently been introduced as an alternative.

This study aimed to compare the surgical outcomes of LAPEG and Open-G in patients for whom percutaneous endoscopic gastrostomy was deemed difficult.

Methodology

A retrospective review was conducted of all patients undergoing gastrostomy at our institution between January 2016 and February 2025. Among 378 total gastrostomies, 16 were classified as difficult, meaning that endoscopic transillumination or the finger sign could not be confirmed, or preoperative imaging revealed organs overlapping the stomach.

Data collected included operative time, blood loss, and perioperative complications. Statistical analyses used chi-square and t-tests, with significance set at P < 0.05.

Results

Sixteen patients were analyzed (four LAPEG and 12 Open-G). Median operative times (49 minutes vs. 55.5 minutes) and blood loss (3.5 g vs. 5 g) did not differ significantly between the LAPEG and open groups, respectively.

Conclusions

Within the limitations of this small, retrospective study, LAPEG was comparable to Open-G in terms of operative time and surgical outcomes.

Future large-scale, prospective studies are necessary to validate these findings and further clarify the clinical benefits of LAPEG in patients with difficult indications for percutaneous endoscopic gastrostomy.