PERCUTANEOUS GASTROPEXY: A NOVEL APPROACH TO A FEARED COMPLICATION OF PERCUTANEOUS GASTROSTOMY TUBE PLACEMENT

Percutaneous endoscopic gastrostomy (PEG) tubes are commonly placed due to the ease and safety of the technique. Although uncommon, complications of this routine procedure can be catastraophic. A 13 month old former premature male developed peritonitis several hours after PEG placement. Following resuscitation, he was brought to the operating room where he was found to have diffuse peritonitis with ascites on initial laparoscopy. The PEG tube was in the stomach; we felt we could salvage the PEG by performing a gastropexy laparoscopically. In addition to the 5mm laparoscope port, two additional 4 mm ports were used to place 3 percutaneous sutures through the anterior abdominal wall. These were bolstered to the skin, and the patient did well post-operatively. The sutures were removed 15 days following the procedure. This video demonstrates a novel approach to addressing a complication of gastrostomy tube placemen

RE-EXPLORATION FOLLOWING LAPAROSCOPIC SLEEVE GASTRECTOMY

A 16 year old female with severe obesity underwent 6 months of multidisciplinary evaluation, after which she was offered laparoscopic sleeve gastrectomy. At surgery, peritoneal access was obtained using a 5mm non-cutting optical port. Sleeve gastrectomy was performed using a 40Fr bougie and multiple staple firings with bioabsorbable staple line reinforcement. On the second post-operative day she was noted to have a low grade fever and low urine output. Her physical exam was otherwise unremarkable and her wbc = 12,900. That evening a computed tomograph of the abdomen with oral contrast showed pneumoperitoneum, no extravisation of contrast from the gastric sleeve, and thickened bowel loops in the left upper abdomen. The following morning she complained of mild diffuse abdominal pain and return to the operating was carried out. At repeat laparoscopy she was found to have a through-and-through injury to the proximal small intestine. The bowel was repaired primarily

Tracheal injury during extraction of an esophageal foreign body: Repair utilizing venovenous ECMO

Extracorporeal membrane oxygenation (ECMO) is a form of life support with an ever-expanding range of indications. Veno-venous (VV) ECMO is often utilized to support children with respiratory compromise, and has been employed successfully in the acute setting of traumatic tracheobronchial injury as well as during elective tracheal surgery. We present a successful case of VV ECMO used in the perioperative management of a tracheal repair for a traumatic laceration caused by attempts to retrieve an esophageal foreign body. While this mechanism of injury appears to be rare, we believe that VV-ECMO allowed for the optimal management of this child and should be considered for other extensive tracheal injuries in children