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This study aims to compare laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a pediatric population to test the hypothesis that there is a difference in the frequency of serious fistula complications between the two methods. Meta-analysis was used. All reports published in the English and Swedish language between 1995 and 2008 on video-assisted, laparoscopic, and percutaneous endoscopic gastrostomy (PEG) in children were included in the study. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Only fistulas requiring re-operation were included. Fisher´s exact probability test was used to calculate the statistical significance of the difference in frequency between the two gastrostomy methods. Out of 801 publications found when using the search terms 48 studies were extracted for this investigation. These studies reported 3441 children undergoing gastrostomy operation, 842 by using the laparoscopic technique and 2599 using the percutaneous endoscopic technique. The number of serious gastrointestinal fistulae to colon or small bowel was 0% and 1, 54% respectively. The results of this meta-analysis suggest that by performing laparoscopic gastrostomy in children one can avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG. However, there is a need for further high-quality randomized trials comparing the two techniques, matched for age and sex as well as for severity of the children's underlying disease.

MeSH