Percutaneous Endoscopic Gastrostomy (PEG) is the standard technique for gastrostomy placement. However, certain children are not candidates for PEG, such as those with craniofacial or foregut anomalies and prior surgery. We describe a technique for gastrostomy that may reduce the morbidity compared to the open or laparoscopic technique.

A 1.4 kg infant with a cleft palate and hypotonia underwent general anesthesia. A single 5 mm laparoscopic port was placed in the left upper quadrant at the site of the intended gastrostomy. Following pneumoperitoneum, a 4 mm bronchoscopic optical grasper was inserted into the abdomen via the single port. The stomach was grasped and pulled out through the port site. The extracorporeal portion of stomach was matured as a gastrostomy. A low profile gastrostomy button was placed.

Proper position of the gastrostomy device was verified intraoperatively utilizing dye. At 2 month follow up the child and gastrostomy are without complication.

This technique is minimally invasive and provides direct visualization through one abdominal port without the requirement of endoscopy or blind percutaneous entrance into the abdomen. The single site laparoscopic gastrostomy is an easy and practical alternative for patients who may not be candidates for PEG.