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      "@value" : "SUMMARY\nAim: Laparoscopic gastrostomy in children has recently\nbecome an established minimally invasive alternative to\nendoscopic insertion. The authors describe a method of\nprimary laparoscopic button gastrostomy, in order to\nemphasize certain technical modifications that make it\nsafer, simpler and more effective than previously reported\ntechniques.\nMaterials and methods: The medical records of 17 children\nwho underwent primary laparoscopic button gastrostomy\nare reviewed. The Seldinger technique was used for the\nbutton insertion and the stomach was fixed to the\nepigastrium with two U-sutures. The modifications of our\ntechnique as compared to others are: 1) the tract is\nminimally dilated to permit a snug fit of the button, 2) a\nsize 12 Fr button is used in all cases and 3) a Tuohy needle\nstabilizes the device to negotiate the tight gastric tract.\nResults: The mean age at operation was 25 months (range\n3 months to 13 years). The main indication for gastrostomy\nwas inability to swallow secondary to neurological\nimpairment (82%). Four patients had concommitant\nlaparoscopic antireflux procedure. The mean hospital stay\nfor gastrostomy alone was three days. The mean follow-up\nwas six months. There was no perioperative mortality or\nmajor life-threatening complications associated with the\ngastrostomy. No complication was serious enough to require\nremoval of the button or hospitalization. There were no\nleaks. The nutritional status improved remarkably in the\nmajority of patients. Conclusions: A primary button gastrostomy can be\nperformed safely under laparoscopic guidance via a single\numbilical port with minimal morbidity. The use of a Tuohy\nneedle for the stabilization of the button facilitates the\nintroduction of even the smallest size of gastrostomy device.\nKey words: Gastrostomy, Button, Laparoscopy, Children"
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