Primary Gastrojejunostomy tube placement using laparoscopy with endoscopic assistance: a novel technique

Abstract Background Gastrojejunostomy (GJ) tubes are commonly used to provide post-pyloric enteral nutrition in pediatric patients who cannot tolerate gastric feeds. Most techniques depend on a pre-existing gastrostomy tube (GT) site to convert to a gastrojejunostomy. Several minimally invasive techniques have been described however their risk profile varies widely. Description of the operative technique We present a technique for primary laparoscopic GJ tube placement that minimizes the risk of hollow viscus injury and the use of fluoroscopy through endoscopic assistance. Results Eleven GJ tubes were placed using this technique in patients ranging from 5 months to 17 years of age and weighing 6.3 to 46.0 kg. Endoscopy through the gastrostomy site allowed direct visualization of wire and tube placement. There were no intra-operative or post-operative complications within 30 days of operation. Use of fluoroscopy was limited with minimal total radiation exposure. Conclusion The described technique of laparoscopic primary gastrojejunostomy tube placement with endoscopic assistance was associated with a low complication rate and minimal use of fluoroscopy. Level of Evidence IV