174 Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Placement for Long-Term Nutritional Support

Abstract Aim Percutaneous endoscopic gastrostomy (PEG) or Radiologically inserted (RIG) tube insertion are commonly used in patients requiring long-term nutritional support particularly after a cerebrovascular Accident (CVA). When this is not possible due to adverse anatomical features such as a large hiatus or para-oesophageal hernia, it can be very difficult to arrange long-term nasogastric feeding in the community. In this patient group, laparoscopic-assisted PEG placement (LPEG) can be used to secure long-term nutritional access. Method A retrospective review of all patients undergoing LPEG insertion was conducted. All the patients required long-term nutritional access, and a best interest meeting was conducted pre-operatively where the patient lacked mental capacity. All cases were performed with laparoscopy and gastroscopy under general anaesthetic. Outcome data was collected on therapeutic success, mortality, length of postoperative stay (pLOS), and discharge destination. Results 13 patients underwent LPEG between 2018 to 2024. The median age was 78 (51-87), and 10 patients (77%) were ASA grade 4. 9 patients (69%) presented with failed swallow due to neurological causes (recent CVA or progressive Multiple Sclerosis). Therapeutic success was 100%, conversion to open surgery was 0%. Median pLOS was 14 days (5-154). All patients were discharged from hospital, including 62% to their own homes. There were no deaths during the index admission. 90-day mortality was 15%, and 77% were alive 1 year postoperatively. Conclusions LPEG both safe and effective in facilitating long-term nutritional access in a high-risk, complex patient group. It also facilitates discharge from an acute hospital setting to either home or a community healthcare environment.