Percutaneous laparoscopic-assisted gastrostomy outperforms surgical gastrostomy for temporary feeding in long-gap esophageal atresia: a comparative cohort study.

OBJECTIVE

This study aims to compare the clinical efficacy of percutaneous laparoscopic-assisted gastrostomy (PLAG) and surgical gastrostomy (SG) for temporary gastrostomy in neonates with long-gap esophageal atresia (LGEA).

METHODS

We conducted a retrospective analysis of 41 neonates diagnosed with LGEA who underwent temporary gastrostomy. Patients were retrospectively divided into two groups based on the year of surgery: the PLAG group (intervention group, n = 23,post-2020) and the SG group (historical control group, n = 18, pre-2020).We compared perioperative parameters, including postoperative fasting duration, gastrostomy closure rates, abdominal scar scores and complication rates between the two groups.

RESULTS

No significant differences were found in baseline characteristics, including gender (p = 0.732), gestational age (p = 0.460), birth weight (p = 0.421), operative age (p = 0.165), Gross classification (p = 0.117), esophageal gap length (p = 0.081), or concomitant deformities (p = 0.767). The two groups showed no statistically significant differences in operative time (p = 0.067), intraoperative blood loss (p = 0.189), or postoperative fasting duration (p = 0.378). However, the PLAG group demonstrated clinically meaningful advantages in several outcomes, including significantly lower rates of gastrostomy closure (p < 0.001), improved cosmetic results (assessed by lower abdominal scar scores; p < 0.001), and reduced complication rates for stoma leakage (p < 0.001), peristomal dermatitis (p < 0.001), local infection (p < 0.001), and tube dislodgement (p = 0.003). No significant differences were noted in stomal hemorrhage (p = 0.083) or intra-abdominal fistula rates (p = 0.252).

CONCLUSION

Compared to SG, PLAG offers significant advantages for temporary gastrostomy in LGEA, including lower closure requirements, improved cosmetic outcomes, and fewer overall complications. These findings support the broader clinical adoption of PLAG in this patient population.