A novel silk suture-assisted laparoscopic technique for the repair of a gastrocolic fistula in a pediatric patient

Percutaneous placement of gastrostomy was first described in 1980. Since then it has become widely used in pediatric surgery throughout the world. Inherent in the technique is the possibility of inadvertent damage to adjacent anatomical structures, most commonly the transverse colon. Management previously had involved laparotomy and correction of the gastrocolic fistula. Here we describe a novel laparoscopic approach to the repair of a gastrocolic fistula following percutaneous gastrostomy, avoiding the morbidity of laparotomy in an immunocompromised patient with a rotund abdomen secondary to steroid usage. 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Gastrostomy tube insertion is a common surgical procedure of our knowledge, there have been no reports of a laparoscopic performed in pediatric patients, particularly in those with neurodevelopmental delay, failure to thrive and gastroesophageal reflux disease [1]. Percutaneous endoscopic gastrostomy (PEG) insertion was initially described in 1980 and very rapidly replaced the open approach to gastrostomy placement. In subsequent years, advances in interventional radiology and laparoscopic techniques have enabled image guided gastrostomy (IG), laparoscopic gastrostomy (LAP-G) insertion and laparoscopic-assisted PEG (LAP-PEG), all of which have become widely accepted alternatives [1,2]. Major complications are rare in all the modalities of gastrostomy placement, being lowest in laparoscopic (LAP-G) or laparoscopicassisted procedures (LAP-PEG) [1]. Complications are lower in PEG than in IG insertion, being 1% and 3% respectively [2]. Gastrocolic fistula is one of the visceral injuries seen in the major complications. It is estimated to be around 1.2e3.5% [2,3]. The meta-analysis published by Baker et al. has highlighted a paucity of literature on the safety of IG in children [1] which creates difficulty in rendering specific risk attribution to this modality. The mainstay of treatment of a gastrocolic fistula is by laparotomy although endoscopic closure has been reported [4]. To the best ative to laparotomy for repair ment, Great Ormond Street Inc. This is an open access article u approach to this complication in children. Here we report the successful closure of a gastrocolic fistula using a laparoscopic technique in an immunocompromised patient.