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Varshney P, N V, Varshney VK, Soni S, B S, Agarwal L, Swami A. Laparoscopic Witzel feeding jejunostomy: a procedure overlooked! JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:28-34. [PMID: 36936038 PMCID: PMC10020746 DOI: 10.7602/jmis.2023.26.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Purpose Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart. Methods A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed. Results Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction. Conclusion Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.
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Affiliation(s)
- Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
- Corresponding author Peeyush Varshney, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area Phase II, Jodhpur 342005, India, E-mail: , ORCID: https://orcid.org/0000-0001-6276-1890
| | - Vignesh N
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Subhash Soni
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Selvakumar B
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ashish Swami
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
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Hsiung T, Chao WP, Chai SW, Chou TC, Wang CY, Huang TS. Laparoscopic vs. open feeding jejunostomy: a systemic review and meta-analysis. Surg Endosc 2022; 37:2485-2495. [PMID: 36513780 DOI: 10.1007/s00464-022-09782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Feeding jejunostomy is a solid way for patients to maintain enteral nutrition. However, debate over the superiority of the laparoscopic vs. laparotomic method has raised concerns in recent years. This systemic review and meta-analysis aimed to compare the postoperative outcomes between these two approaches. METHODS We searched PubMed, Embase, and Scopus from the date of inception to April 2022 for studies comparing laparoscopic and open feeding jejunostomy. Study characteristics and outcomes were extracted from the included articles. The primary outcome was the relative risk (RR) of postoperative complications in each group. We also analyzed the major/minor complication rates and operations, excluding major concomitant procedures. The risk of bias of included studies were assessed using the ROBINS-I tool. The certainty of evidence was rated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of seven retrospective studies with 1195 patients in total were included in this systemic review and meta-analysis. Laparoscopic feeding jejunostomy carried a significantly lower postoperative complication rate (RR: 0.62; 95% CI, 0.42-0.91, p = 0.02, low certainty of evidence) compared with laparotomy, and the heterogeneity was moderate (I2 = 34%, p = 0.18). After excluding major concomitant procedures, the RR between the laparoscopic and open group was 0.48 (95% CI, 0.33-0.70, p < 0.001, low certainty of evidence), suggesting that the laparoscopic approach was superior in terms of postoperative complications. CONCLUSIONS Our results indicate that laparoscopic feeding jejunostomy might reduce the postoperative overall complication rate compared with open feeding jejunostomy.
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Affiliation(s)
- Ted Hsiung
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Wu-Po Chao
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Shion Wei Chai
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ta-Chun Chou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Chih-Yuan Wang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ting-Shuo Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan. .,Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, 259, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 20401, Taiwan.
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Tsuchiya H, Yasufuku I, Okumura N, Matsuhashi N, Takahashi T. Laparoscopic jejunostomy for enteral nutrition in gastric cancer patients: A report of two cases: A case report. Int J Surg Case Rep 2022; 97:107388. [PMID: 35868129 PMCID: PMC9403088 DOI: 10.1016/j.ijscr.2022.107388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Jejunostomy is often indicated for patients with oral intake difficulties and unresectable gastric cancer, patients at risk of postoperative complications, and patients who require nutritional management after gastrectomy. In this report, we discuss the cases with laparoscopic jejunostomy in our department. CASE PRESENTATION Case 1: An upper gastrointestinal endoscopy performed for close examination in a 60-year-old male revealed upper gastric cancer with extensive invasion and lower esophageal stenosis. He had difficulty with esophageal transit and, consequently, underwent a laparoscopic jejunostomy and staging laparoscopy. Case 2: Upper gastrointestinal endoscopy in a 62-year-old male revealed type 3 tumor in the gastric antrum. He had a history of chronic obstructive pulmonary disease requiring home oxygen therapy, pulmonary hypertension, and heart failure, and was at a high perioperative risk. Consequently, both laparoscopic distal gastrectomy and laparoscopic jejunostomy were performed. CLINICAL DISCUSSION Enteral nutrition has many advantages over venous nutrition, including maintenance of immunity and intestinal mucosa, avoidance of bacterial translocation, and decreased risk of catheter infection. Although there are a few reports of cases with laparoscopic jejunostomy, it is expected that the technique will become more widespread and safe in the future. CONCLUSION Laparoscopic jejunostomy is considered a useful, minimally invasive, and safe technique.
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Deliwala SS, Chandan S, Kumar A, Mohan B, Ponnapalli A, Hussain MS, Kaushal S, Novak J, Chawla S. Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis. Endosc Int Open 2022; 10:E488-E520. [PMID: 35433212 PMCID: PMC9010104 DOI: 10.1055/a-1774-4736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background and study aims Endoscopic methods of delivering uninterrupted feeding to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) or PEG with jejunal extension (PEG-J), validated from small individual studies. We aim to perform a meta-analysis to assess their effectiveness and safety in a variety of clinical scenarios. Methods Major databases were searched until June 2021. Efficacy outcomes included technical and clinical success, while safety outcomes included adverse events (AEs) and malfunction rates. We assessed heterogeneity using I 2 and classic fail-safe to assess bias. Results 29 studies included 1874 patients (983 males and 809 females); mean age of 60 ± 19 years. Pooled technical and clinical success rates with DPEJ were 86.6 % (CI, 82.1-90.1, I 2 73.1) and 96.9 % (CI, 95.0-98.0, I 2 12.7). The pooled incidence of malfunction, major and minor AEs with DPEJ were 11 %, 5 %, and 15 %. Pooled technical and clinical success for PEG-J were 94.4 % (CI, 85.5-97.9, I 2 33) and 98.7 % (CI, 95.5-99.6, I 2 < 0.001). The pooled incidence of malfunction, major and minor AEs with DPEJ were 24 %, 1 %, and 25 %. Device-assisted DPEJ performed better in altered gastrointestinal anatomy. First and second attempts were 87.6 % and 90.2 %. Conclusions DPEJ and PEG-J are safe and effective procedures placed with high fidelity with comparable outcomes. DPEJ was associated with fewer tube malfunction and failure rates; however, it is technically more complex and not standardized, while PEG-J had higher placement rates. The use of balloon enteroscopy was found to enhance DPEJ performance.
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Affiliation(s)
- Smit S. Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, United States
| | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States
| | - Anand Kumar
- Gastroenterology & Hepatology, Lenox Hill Hospital, New York, New York, United States
| | - Babu Mohan
- Gastroenterology & Hepatology, University of Utah, Salt Lake City, Utah, United States
| | - Anoosha Ponnapalli
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, United States
| | - Murtaza S. Hussain
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, United States
| | - Sunil Kaushal
- Gastroenterology, Mclaren Health Corporation, Flint, Michigan, United States
| | - Joshua Novak
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Saurabh Chawla
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
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Mastoridis S, Bracalente G, Hanganu CB, Neccia M, Giuliani A, Gillies R, Marshall R, Maynard N, Sgromo B. Laparoscopic vs. open feeding jejunostomy insertion in oesophagogastric cancer. BMC Surg 2021; 21:367. [PMID: 34645433 PMCID: PMC8513201 DOI: 10.1186/s12893-021-01318-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 06/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. METHODS A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. RESULTS In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs. 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). CONCLUSIONS This report represents the largest to our knowledge single-centre comparison of open vs. laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.
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Affiliation(s)
- Sotiris Mastoridis
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | | | | | | | | | - Richard Gillies
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | - Robert Marshall
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | - Nicholas Maynard
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK
| | - Bruno Sgromo
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford, OX3 7LE, UK.
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Kim CY, Shin JH. Recent update of percutaneous radiologic jejunostomy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Charles Y. Kim
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
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Kim CY, Dai R, Wang Q, Ronald J, Zani S, Smith TP. Jejunostomy Tube Insertion for Enteral Nutrition: Comparison of Outcomes after Laparoscopic versus Radiologic Insertion. J Vasc Interv Radiol 2020; 31:1132-1138. [PMID: 32460963 DOI: 10.1016/j.jvir.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To retrospectively compare technical success and major complication rates of laparoscopically versus radiologically inserted jejunostomy tubes. MATERIALS AND METHODS In this single-institution retrospective study, 115 patients (60 men; mean age, 59.7 y) underwent attempted laparoscopic jejunostomy tube insertion as a standalone procedure during a 10-year period and 106 patients (64 men; mean age, 61.0 y) underwent attempted direct percutaneous radiologic jejunostomy tube insertion during an overlapping 6-year period. Clinical outcomes were retrospectively reviewed with primary focus on predictors of procedure-related major complications within 30 days. RESULTS Patients undergoing laparoscopic jejunostomy tube insertion were less likely to have previous major abdominal surgery (P < .001) or to be critically ill (P < .001) and had a higher body mass index (P = .001) than patients undergoing radiologic insertion. Technical success rates were 95% (110 of 115) for laparoscopic and 97% (103 of 106) for radiologic jejunostomy tube insertion (P = .72). Major procedural complications occurred in 7 patients (6%) in the laparoscopic group and in 5 (5%) in the radiologic group (P = 1.0). For laparoscopic jejunostomy tubes, only previous major abdominal surgery was significantly associated with a higher major procedure complication rate (14% [5 of 37] vs 3% [2 of 78] in those without; P = .039). In the radiologic jejunostomy group, only obesity was significantly associated with a higher major complication rate: 20% (2 of 10) vs 3% (3 of 96) in nonobese patients (P = .038). CONCLUSIONS Laparoscopic and radiologic jejunostomy tube insertion both showed high success and low complication rates. Previous major abdominal surgery and obesity may be pertinent discriminators for patient selection.
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Affiliation(s)
- Charles Y Kim
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710.
| | - Rui Dai
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710
| | - Qi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - James Ronald
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710
| | - Sabino Zani
- Department of Surgery, Duke University Medical Center, Box 3808, Durham, NC, 27710
| | - Tony P Smith
- Division of Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710
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8
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Collard MK, Genser L, Vaillant JC. Re Re : laparoscopic direct feeding jejunostomy. J Visc Surg 2020; 157:167-168. [PMID: 31959468 DOI: 10.1016/j.jviscsurg.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M K Collard
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - L Genser
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
| | - J C Vaillant
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
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Nagata K, Tsujimoto H, Nagata H, Harada M, Ito N, Nomura S, Horiguchi H, Hiraki S, Aosasa S, Hase K, Ueno H. Nutritional benefit of laparoscopic jejunostomy during neoadjuvant chemotherapy for obstructing esophageal cancer. Mol Clin Oncol 2019; 11:612-616. [PMID: 31692945 DOI: 10.3892/mco.2019.1938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/04/2019] [Indexed: 01/19/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) confers a survival benefit in esophageal carcinoma, but it is difficult to perform in patients who cannot receive enteral feeding due to an esophageal obstruction. In the current study, the nutritional benefit of laparoscopic jejunostomy (Lap-J) was evaluated in patients with NAC for obstructing esophageal cancer. A total of 91 patients with esophageal cancer who received NAC between 2009 and 2017 were included in the present study. Lap-J was performed prior to NAC in 15 patients (16.5%) with an obstructing tumor. Patients with NAC without Lap-J were used as the control group (n=76). Nutritional parameters and surgical outcomes of the two groups were compared retrospectively. In the patients with Lap-J, 14 of the 15 patients (93.3%) did not experience any procedure-associated complications. No mortalities were associated with Lap-J. Significant decreases in total serum protein, albumin, hemoglobin concentrations and prognostic nutritional index (PNI) occurred following NAC in the control but not in the Lap-J group. Serum albumin and the improved modified Glasgow prognostic score increased significantly after NAC in the Lap-J group but not in the control group. In conclusion, perioperative nutritional support with Lap-J was safe and effective in patients with NAC for obstructing esophageal cancer.
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Affiliation(s)
- Ken Nagata
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hiromi Nagata
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shuichi Hiraki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Siow SL, Mahendran HA, Wong CM, Milaksh NK, Nyunt M. Laparoscopic T-tube feeding jejunostomy as an adjunct to staging laparoscopy for upper gastrointestinal malignancies: the technique and review of outcomes. BMC Surg 2017; 17:25. [PMID: 28320382 PMCID: PMC5359869 DOI: 10.1186/s12893-017-0221-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, staging laparoscopy has gained acceptance as part of the assessment of resectability of upper gastrointestinal (UGI) malignancies. Not infrequently, we encounter tumours that are either locally advanced; requiring neoadjuvant therapy or occult peritoneal disease that requires palliation. In all these cases, the establishment of enteral feeding during staging laparoscopy is important for patients’ nutrition. This review describes our technique of performing laparoscopic feeding jejunostomy and the clinical outcomes. Methods The medical records of all patients who underwent laparoscopic feeding jejunostomy following staging laparoscopy for UGI malignancies between January 2010 and July 2015 were retrospectively reviewed. The data included patient demographics, operative technique and clinical outcomes. Results Fifteen patients (11 males) had feeding jejunostomy done when staging laparoscopy showed unresectable UGI maligancy. Eight (53.3%) had gastric carcinoma, four (26.7%) had oesophageal carcinoma and three (20%) had cardio-oesophageal junction carcinoma. The mean age was 63.3 ± 7.3 years. Mean operative time was 66.0 ± 7.4 min. Mean postoperative stay was 5.6 ± 2.2 days. Laparoscopic feeding jejunostomy was performed without intra-operative complications. There were no major complications requiring reoperation but four patients had excoriation at the T-tube site and three patients had tube dislodgement which required bedside replacement of the feeding tube. The mean duration of feeding tube was 127.3 ± 99.6 days. Conclusions Laparoscopic feeding jejunostomy is an important adjunct to staging laparoscopy that can be performed safely with low morbidity. Meticulous attention to surgical techniques is the cornerstone of success.
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Affiliation(s)
- Sze Li Siow
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Kuching, Sarawak, Malaysia.,Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | | | - Chee Ming Wong
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Kuching, Sarawak, Malaysia.,Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | | | - Myo Nyunt
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Kuching, Sarawak, Malaysia.
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Laparoscopic percutaneous jejunostomy with intracorporeal V-Loc jejunopexy in esophageal cancer. Surg Endosc 2016; 31:2678-2686. [PMID: 27752817 DOI: 10.1007/s00464-016-5285-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Barbed sutures are widely used in various laparoscopic digestive surgeries. The purpose of this paper is to present our initial experience of laparoscopic percutaneous jejunostomy with unidirectional barbed sutures in esophageal cancer patients and compare it with our early cases using traditional transabdominal sutures. METHODS A total of 118 esophageal cancer patients who underwent laparoscopic percutaneous jejunostomy were identified in a single institution in Taiwan from June 2014 to May 2016. The authors' traditional technique consisted of using transabdominal sutures with bolsters to fix a jejunum loop onto the anterior abdominal wall. A novel technique was introduced using intracorporeal suturing with knotless unidirectional barbed monofilament absorbable sutures (V-Loc) to attain a seal around the feeding catheter. A comparison between these two techniques was performed. RESULTS Twenty cases with barbed V-Loc sutures and 98 cases with transabdominal sutures were identified. The V-Loc sutures appeared to reduce peristomal skin ulcers (19.4 vs. 0 %, p = 0.040), postoperative pain scores during the first 24 h (1.8 ± 1.4 vs. 0.9 ± 1.1, p = 0.007) and on postoperative day 2 (1.7 ± 1.4 vs. 1.0 ± 0.8, p = 0.026) when compared to patients receiving transabdominal sutures. The mean suturing time using V-Loc sutures was 22 min (14-60 min). The mean onset to resumption of enteral feeding was 1.8 ± 0.8 days and the mean duration of postoperative hospital stay was 8 ± 5.1 days, both of which were comparable in the two groups. There was no surgical mortality in our series. CONCLUSIONS In the study cohort, the use of knotless unidirectional barbed sutures instead of traditional transabdominal sutures had similar outcomes and appears to be a feasible option for intracorporeal jejunopexy when performing laparoscopic jejunostomy in patients with esophageal cancer.
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12
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Ye P, Zeng L, Sun F, An Z, Li Z, Hu J. A new modified technique of laparoscopic needle catheter jejunostomy: a 2-year follow-up study. Ther Clin Risk Manag 2016; 12:103-8. [PMID: 26869794 PMCID: PMC4734724 DOI: 10.2147/tcrm.s87071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to establish a modified technique for performing laparoscopic needle catheter jejunostomy. Methods From May 2011 to October 2013, laparoscopic needle catheter jejunostomy was performed in 21 patients with esophageal cancer. During the procedure, jejunal inflation was performed via a percutaneous 20-gauge intravenous catheter to facilitate the subsequent puncture of the jejunal wall by the catheter needle. The success rate, procedure time, complications, and short-term outcomes were evaluated. Results All laparoscopic needle catheter jejunostomies were technically successful, with no perioperative mortality or conversion to a laparotomy. The operation required a mean time of 51.4±14.2 (range 27–80) minutes, and operative bleeding range was 5–20 mL. There was one reoperation required for one patient on postoperative day 5, because the feeding tube was accidentally pulled out during sleep, by patient himself, and the second laparoscopic jejunostomy for this patient was performed successfully. One patient had puncture site pain and was successfully treated with oral analgesics. Other complications, such as gastrointestinal bleeding, intestinal perforation, intestinal obstruction, tube dysfunction, pericatheter leakage, and infection at the skin insertion site, were not observed. The 30-day mortality rate was 4.8% (one out of 21), which was not attributed to the procedure. Enteral nutrition was gradually administered 24–48 hours after operation. Conclusion The novel modified technique of laparoscopic needle catheter jejunostomy is a technically feasible, with a high technical success rate and low complication rate. Its specific advantage is simplicity and safety, and this modified approach can be considered for routine clinical use after long-term outcome evaluation.
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Affiliation(s)
- Peng Ye
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Liping Zeng
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Fenghao Sun
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Zhou An
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Zhoubin Li
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Shenoy J, Adapala RKR. Study of Feeding Jejunostomy as an Add on Procedure in Upper Gastrointestinal Surgeries. Indian J Surg 2016; 77:275-82. [PMID: 26730009 DOI: 10.1007/s12262-012-0795-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 12/02/2012] [Indexed: 12/26/2022] Open
Abstract
Jejunostomy is usually indicated as an additional procedure during major surgery of upper digestive tract to administer enteral nutrition in post-operative period. Complications associated with it can be mechanical, infectious, gastrointestinal or metabolic. The aim of the study was to evaluate safety of post-operative feeding jejunostomy in different types of major upper gastrointestinal surgeries. It was a prospective study conducted during the period between August 2009 and September 2011. Post-operative cases of major upper gastrointestinal surgeries who receive jejunostomy feeds were included in the study. Sampling was done by convenient method with sample size of 50 cases. Post-operatively, patients were monitored according to standard orders of enteral nutrition. Total calorie and protein intake through feeding jejunostomy was calculated regularly, and complications were assessed in terms of frequency, type, duration, management, and final outcome in different types of upper gastro intestinal surgeries. Analysis was done using chi square test with the help of statistical package SPSS vers.13. P < 0.05 was considered as significant. Complications observed were gastrointestinal -8 (16 %), mechanical -6 (12 %), infectious -4 (8 %) and metabolic -4 (8 %). Duration of complications ranged from 1 to 7 days (mean, 4 days). All types of complications observed during study were less severe and could be managed by simple measurements. Haemoglobin, serum albumin and weight of the patient at the time of discharge were improved for all patients when compared to pre-operative values. All patients received target calories and proteins through feeding jejunostomy. Considering benefits of enteral feeding via jejunostomy tube with minor and acceptable complications, we conclude that feeding jejunostomy is a preferred route of nutritional administration in those who undergo major upper gastro intestinal surgeries.
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Affiliation(s)
- Jayarama Shenoy
- Department of Surgery, Kasturba Medical College, Manipal University, Mangalore, India
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Athanasiou A, Spartalis E, Alexandrou A, Liakakos T. Comment on "Laparo-Endoscopic Gastrostomy (LEG) Decompression: a Novel One-time Method of Management of Gastric Leaks Following Sleeve Gastrectomy". Obes Surg 2015; 26:620-1. [PMID: 26694211 DOI: 10.1007/s11695-015-2015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antonios Athanasiou
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| | - Eleftherios Spartalis
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| | - Andreas Alexandrou
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| | - Theodoros Liakakos
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
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Tsujimoto H, Hiraki S, Takahata R, Nomura S, Ito N, Kanematsu K, Horiguchi H, Aosasa S, Yamamoto J, Hase K. Laparoscopic jejunostomy for obstructing upper gastrointestinal malignancies. Mol Clin Oncol 2015; 3:1307-1310. [PMID: 26807238 DOI: 10.3892/mco.2015.612] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/11/2015] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to describe a minimally invasive laparoscopic jejunostomy (Lap-J) technique for obstruction due to upper gastrointestinal malignancies and evaluate the nutritional benefit of Lap-J during neoadjuvant chemotherapy (NAC) in cases with obstructing esophageal cancer. Under general anesthesia, the jejunum 20-30 cm distant from the Treitz ligament was pulled out through an extended umbilical laparoscopic incision and a jejunal tube was inserted to 30 cm. The loop of bowel was gently returned to the abdomen and the feeding tube was drawn through the abdominal wall via the left lower incision. The jejunum was then laparoscopically sutured to the anterior abdominal wall. Lap-J was performed in 26 cases. The median operative time was 82 min. The postoperative course was uneventful. Lap-J prior to NAC was not associated with a decrease in body weight or serum total protein during NAC, compared with patients who received NAC without Lap-J. This minimally invasive jejunostomy technique may be particularly useful in patients in whom endoscopic therapy is not feasible due to obstruction from upper gastrointestinal malignancies.
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Affiliation(s)
- Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shuichi Hiraki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Risa Takahata
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Kyohei Kanematsu
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Young MT, Troung H, Gebhart A, Shih A, Nguyen NT. Outcomes of laparoscopic feeding jejunostomy tube placement in 299 patients. Surg Endosc 2015; 30:126-31. [PMID: 25801114 DOI: 10.1007/s00464-015-4171-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/06/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Jejunostomy catheters for jejunal feeding are an effective method to improve nutritional status in malnourish patients. However, this procedure is commonly being performed using an open approach, which can be associated with more postoperative pain and prolonged recovery. The objective of this study was to assess the outcomes of patients who underwent placement of feeding jejunostomy using a laparoscopic approach. METHODS A retrospective review was performed of patients who underwent laparoscopic jejunostomy tube placement between 1998 and 2014. Main outcome measures included indication for catheter placement, rate of conversion rate to open surgery, perioperative and late morbidity and in-hospital mortality. RESULTS Two hundred and ninety-nine consecutive patients underwent laparoscopic jejunostomy during the study period. The mean age was 64 years, and 81% of patients were male. The mean BMI was 26.2 kg/m(2). The most common indications for catheter placement were resectable esophageal cancer (78%), unresectable esophageal cancer (10%) and gastric cancer (6%). There were no conversions to open surgery. The 30-day complication rate was 4.0% and included catheter dislodgement (1%), intraperitoneal catheter displacement (0.7%), catheter blockage (1%) or breakage (0.3%), site infection requiring catheter removal (0.7%) and abdominal wall hematoma (0.3%). The late complication rate was 8.7% and included jejuno-cutaneous fistula (3.7%), jejunostomy tube dislodgement (3.3%), broken or clogged J-tube (1.3%) and small bowel obstruction (0.3%). The 30-day mortality was 0.3% for a patient with stage IV esophageal cancer who died in the postoperative period secondary to respiratory failure. CONCLUSION In this large consecutive series of feeding jejunostomy, the laparoscopic approach is feasible and safe and associated with a low rate of small bowel obstruction and no intraabdominal catheter-related infection.
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Affiliation(s)
- Monica T Young
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
| | - Hung Troung
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Alana Gebhart
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Anderson Shih
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
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Liu YY, Liao CH, Chen CC, Tsai CY, Liu KH, Wang SY, Fu CY, Yeh CN, Yeh TS. Single-Incision Laparoscopic-Assisted Jejunostomy Tube Placement. J Laparoendosc Adv Surg Tech A 2014; 24:22-7. [DOI: 10.1089/lap.2013.0360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yu-Yin Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Morrison JJ, McVinnie DW, Suiter PA, de Quadros NM. Percutaneous jejunostomy: repeat access at the healed site of prior surgical jejunostomy with US and fluoroscopic guidance. J Vasc Interv Radiol 2013. [PMID: 23177111 DOI: 10.1016/j.jvir.2012.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of ultrasound (US)- and fluoroscopy-guided jejunostomy tube placement in patients with a history of surgical jejunostomy. MATERIALS AND METHODS Between June 2003 and June 2012, percutaneous US-guided jejunostomy placement was attempted 28 times in 26 patients with a history of surgical jejunostomy (14 men and 12 women). Retrospective chart review was performed to determine procedural success, complications, and interval between original jejunostomy and new tube placement. Clinical outcomes were evaluated with a mean follow-up period of 110 days (range, 3-631 d; median, 68 d). RESULTS Successful tube placement was achieved in 26 of 28 attempts (92%). The mean time between removal of the original surgical jejunostomy and percutaneous placement of the new tube was 278 days (range, 3 d to 8 y; median, 88 d). A single minor complication involved a tube site infection 4 days after the procedure. There were no major complications. Mean procedure time was 49 minutes (range, 15-125 min; median, 45 min). CONCLUSIONS Percutaneous jejunostomy access can be reliably and safely reestablished with US and fluoroscopic guidance in patients with a history of surgical jejunostomy.
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Affiliation(s)
- James J Morrison
- Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.
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Trocar guided laparoscopic feeding jejunostomy: a simple new technique. Surg Laparosc Endosc Percutan Tech 2013; 22:e250-3. [PMID: 23047399 DOI: 10.1097/sle.0b013e31826366ff] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Several techniques of laparoscopic feeding jejunostomy have been described. Most of them require costly commercial kits. Here we present a novel, simple, low-cost method for laparoscopic jejunostomy tube placement. METHODS This technique involves 4 ports. A left lateral "guide" trocar is used as a landmark for tube placement. A jejunal loop is selected and 4 vicryl sutures are placed in a diamond shape on the antimesenteric side of the intestine and left untied. These 4 stitches are extracted using a transabdominal suture grasper inserted through 4 small incisions around the left lateral guide trocar. After an enterotomy is made in the center of these 4 stitches using cautery device, the left lateral trocar is removed and a 12 Fr Foley catheter is inserted in the trocar site and introduced into the bowel. The 4 stitches are pulled toward the abdominal wall and gently tied without additional suturing. Eight patients who underwent this procedure between 2007 and 2009 were reviewed. RESULTS The procedure was successful in all patients. The median operative time was 70.5 minutes. There were no postoperative complications with respect to infection, bleeding, or bowel obstruction, and no perioperative mortality. CONCLUSIONS Our trocar-guided approach for laparoscopic feeding jejunostomy placement is a simple, cost-effective, safe, and effective method.
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Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and complications. Eur J Trauma Emerg Surg 2013; 39:235-42. [PMID: 26815229 DOI: 10.1007/s00068-013-0274-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/11/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients. OBJECTIVE To review the current techniques of gastrointestinal tract access for EN. METHODS For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: "enteral nutrition," "critically ill," and "gut access." We excluded outdated abstracts. RESULTS For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN through the stomach, so postpyloric tube feeding is not needed initially. CONCLUSION In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen.
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Lo HC, Wang YC, Hsu CH, Wu SC, Huang JC, Cheng HT, Hsieh CH. A Modified and Simplified Technique for Laparoscopic Tube Jejunostomy. Am Surg 2012. [DOI: 10.1177/000313481207800513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hung-Chieh Lo
- Department of Trauma and Emergency Surgery China Medical University Hospital China Medical University Taichung, Taiwan
| | - Yu-Chun Wang
- Department of Trauma and Emergency Surgery China Medical University Hospital and School of Medicine China Medical University Taichung, Taiwan
| | - Cheng-Hsiung Hsu
- Department of Trauma and Emergency Surgery China Medical University Hospital China Medical University Taichung, Taiwan
| | - Shih-Chi Wu
- Department of Trauma and Emergency Surgery China Medical University Hospital and School of Medicine China Medical University Taichung, Taiwan
| | - Jui-Chien Huang
- Department of Trauma and Emergency Surgery China Medical University Hospital China Medical University Taichung, Taiwan
| | - Han-Tsung Cheng
- Department of Trauma and Emergency Surgery China Medical University Hospital China Medical University Taichung, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery China Medical University Hospital and School of Medicine China Medical University Taichung, Taiwan
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22
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Totally laparoscopic feeding jejunostomy - a technique modification. Wideochir Inne Tech Maloinwazyjne 2011; 6:256-60. [PMID: 23255990 PMCID: PMC3516942 DOI: 10.5114/wiitm.2011.26262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 05/05/2011] [Accepted: 05/28/2011] [Indexed: 02/07/2023] Open
Abstract
In oncological patients with upper gastrointestinal tract tumours, dysphagia and cachexy necessitate gastrostomy or jejunostomy as the only options of enteral access for long-term feeding. In this article the authors describe a modified technique of laparoscopic feeding jejunostomy applied during the staging laparoscopy. A 48-year-old male patient with gastroesophageal junction tumour and a 68-year-old male patient with oesophageal tumour were operated on using the described technique. Exploratory laparoscopy was performed. Then the feeding jejunostomy was made using a Cystofix® TUR catheter. The jejunum was fixed to the abdominal wall with four 2.0 Novafil™ transabdominal stitches. Two additional sutures were placed caudally about 4 cm and 8 cm from the jejunostomy, aiming at prevention of jejunal torsion. Total operating time was 45 min. There was no blood loss. There were no intraoperative complications. The only adverse event was one jejunostomy wound infection that responded well to oral antibiotics. There were no mortalities. The described technique has most of the benefits of laparoscopic feeding jejunostomy with some steps added from the open operation making the procedure easier to perform as part of a staging operation with a relatively short additional operating time. The proposed transabdominal stitches make the technique easier to apply. Two additional ‘anti-torsion sutures’ prevent postoperative volvulus. Use of the Cystofix catheter allows easy introduction of the catheter into the peritoneal cavity and the jejunal lumen, providing a good seal at the same time. Further studies on larger groups of patients are required to assess long-term outcomes of the proposed modified technique.
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23
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Silberman H, Powers M. Fluids, Electrolytes, and Nutrition. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Laparoscopic feeding jejunostomy: description of a modified technique with results. Surgeon 2011; 10:59-62. [PMID: 22233556 DOI: 10.1016/j.surge.2010.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/23/2010] [Accepted: 11/24/2010] [Indexed: 11/21/2022]
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25
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Kulvatunyou N, Joseph B, Tang A, O'Keeffe T, Wynne JL, Friese RS, Latifi R, Rhee P. Gut access in critically ill and injured patients: Where have we gone thus far? Eur Surg 2011. [DOI: 10.1007/s10353-011-0590-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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26
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Dhahri A, Verhaeghe P, Hajji H, Fuks D, Badaoui R, Deguines JB, Regimbeau JM. Sleeve gastrectomy: Technique and results. J Visc Surg 2010; 147:e39-46. [DOI: 10.1016/j.jviscsurg.2010.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Hu HT, Shin JH, Song HY, Kim JH, Yoon HK, Gwon DI, Ko GY, Sung KB. Fluoroscopically guided percutaneous jejunostomy with use of a 21-gauge needle: a prospective study in 51 patients. J Vasc Interv Radiol 2009; 20:1583-7. [PMID: 19854072 DOI: 10.1016/j.jvir.2009.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 08/14/2009] [Accepted: 08/15/2009] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To assess the safety and clinical efficacy of fluoroscopically guided percutaneous jejunostomy with use of a 21-gauge needle and a single anchor technique in 51 patients. MATERIALS AND METHODS From November 2006 to January 2009, 51 consecutive patients (42 men and nine women; mean age, 63.7 years) underwent percutaneous jejunostomy under fluoroscopic guidance. A 7.5-F multifunctional coil catheter was used to insufflate the jejunum. The distended jejunum was punctured with a 21-gauge needle, with the inserted coil catheter as the target. A single anchor was used. The technical success, number of punctures, procedure time, complications, and follow-up data including 30-day mortality rate were evaluated. RESULTS The technical success rate was 100%, and the single anchor technique was used in all but one patient, in whom three anchors were used. The mean number of punctures was 1.7 (range, 1-4), and the mean procedure time was 14.8 minutes (range, 7-29 min). Peritonitis was a major complication in two patients (3.9%), who were treated by changing the catheters from 14 F to 16 F and performing percutaneous drainage procedures. Three minor complications were encountered: superficial cellulitis (n = 2) and severe puncture site pain (n = 1). The 30-day mortality rate was 5.9% (three of 51), although none of the deaths could be attributed to the jejunostomy procedures. CONCLUSIONS Fluoroscopically guided percutaneous jejunostomy with use of a 21-gauge needle and the single anchor technique seems to be safe and effective, with high technical success and low complication rates.
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Affiliation(s)
- Hong-Tao Hu
- Department of Radiology, Henan Tumor Hospital, Zhengzhou, China
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T-tube gastrostomy as a novel approach for distal staple line disruption after sleeve gastrectomy for morbid obesity: case report and review of the literature. Obes Surg 2009; 20:519-22. [PMID: 19575273 DOI: 10.1007/s11695-009-9898-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 06/01/2009] [Indexed: 01/30/2023]
Abstract
Laparoscopic sleeve gastrectomy has recently become a feasible option in the management of morbid obesity. One of the most feared complications of this procedure is staple line disruption and leakage. There are, to our knowledge, few literature reports that try to explain the reasons and management of this rare but serious complication. We report a case of staple line disruption that was managed using a T-tube gastrostomy. A 50-year-old female, 2 weeks status post-sleeve gastrectomy in an outside facility, was admitted to the emergency room at Cleveland Clinic Florida with new onset of fever, abdominal pain, jaundice, hematemesis, and melena. A computed tomography scan of the abdomen revealed a large extravasation of contrast material parallel to the gastric sleeve. A diagnostic laparoscopy was performed that showed a distal and proximal disruption of the staple line. A T-tube gastrostomy with a large proximal and distal limb was placed into the most distal area of disruption. After thorough over sewing and drainage of the proximal site and T-tube, a feeding jejunostomy was placed. The T-tube permitted to control the leak and to have a controlled fistula. Four weeks postoperatively, the T-tube was removed after the patient had a negative Gastrografin study and tolerated oral fluids with a clamped T-tube. The long-term recovery and follow-up were uneventful. T-tube gastrostomy appears to be a safe and feasible treatment option for staple line disruption after vertical sleeve gastrectomy. Early detection and drainage remain the most important principles to manage this type of complication.
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Abstract
The primary indication for an esophagectomy is esophageal cancer or Barrett's esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy is a major surgery involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to allow healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach). Placement of a feeding jejunostomy preoperatively or at time of surgery provides enteral access for patients who will experience eating challenges and a slow transition back to a normal diet, challenges that often lead to weight loss in the postoperative period. Supplemental tube feeding given nocturnally can provide a consistent intake while appetite, swallowing, and diet advancements improve during the convalescent period. The postesophagectomy diet advances from liquids to soft solids with restrictions to reduce discomfort and aid swallowing and digestion. The esophagectomy patient will experience physical, dietary, and social adaptation for several months postoperatively. Attention to nutrition throughout the process of diagnosis, treatment, and postoperative care is essential for optimal care of the esophagectomy patient.
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Affiliation(s)
- Cassandra E Kight
- University of Wisconsin Hospital and Clinics, Clinical Nutrition Services, 600 Highland Avenue, Madison, WI 53792, USA.
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Rezaii J, Hajimohama F, Esfandiari K, Mirzazadeh M, Basiri A. Time of Jejunostomy after Upper Gastrointestinal and Respiratory
Tract Cancers would be Affecting on Complications of Jejunostomy. JOURNAL OF MEDICAL SCIENCES 2008. [DOI: 10.3923/jms.2008.583.586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mackenzie SH, Haslem D, Hilden K, Thomas KL, Fang JC. Success rate of direct percutaneous endoscopic jejunostomy in patients who are obese. Gastrointest Endosc 2008; 67:265-9. [PMID: 17996236 DOI: 10.1016/j.gie.2007.06.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 06/18/2007] [Indexed: 01/24/2023]
Abstract
BACKGROUND Direct percutaneous endoscopic jejunostomy (DPEJ) is increasingly used as a method for obtaining jejunal enteral access. The most cited reason of unsuccessful placement is poor transillumination, which may be related to obesity. Whether obesity affects failure and complication rates has not been previously described. OBJECTIVE To compare the success rate and adverse events (AEs) associated with DPEJ placement in patients who were overweight and patients who were obese compared with patients who were normal or underweight defined by body mass index (BMI). DESIGN Retrospective database review. SETTING A tertiary-referral center. PATIENTS Eighty DPEJ placements between February 2000 and September 2005. MAIN OUTCOME MEASUREMENTS DPEJ placement success in patients who were overweight/obese (BMI >or= 25) versus patients who were normal or underweight (BMI <25). Secondary end points included procedure time and AEs. RESULTS Eighty DPEJs were placed in 75 patients. Of these DPEJs, 65 (81%) succeeded and 15 (19%) failed. Success rates were 23 of 24 for patients who were underweight (96%), 25 of 31 for patients with normal BMI (81%), 8 of 11 for patients who were overweight (73%), and 6 of 10 for persons who were obese (60%) (odds ratio 3.43, 95% CI 1.03-11.44; P< .05 for BMI >or= 25 vs BMI<25). Overall, AEs were not significantly different for patients with BMI <25 versus BMI >or=25 (24/55 vs 9/21, respectively; P= .64). However, 4 of the 5 severe AEs occurred in patients with a BMI >or= 25 (P= .07). LIMITATIONS Retrospective single center. CONCLUSIONS DPEJ placement in patients who were overweight or obese was feasible, but procedural success was less frequent, and a trend toward more frequent major AEs was seen than in persons with normal or decreased BMI. BMI was an easily assessed preprocedural factor for DPEJ success and complication rates.
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Affiliation(s)
- Scott H Mackenzie
- Division of Gastroenterology, University of Utah, Salt Lake City, Utah 84132, USA
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Maple JT. Direct percutaneous endoscopic jejunostomy in the obese: proceed with caution. Gastrointest Endosc 2008; 67:270-2. [PMID: 18226689 DOI: 10.1016/j.gie.2007.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 09/11/2007] [Indexed: 02/08/2023]
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Sparrow P, David E, Pugash R. Direct percutaneous jejunostomy--an underutilized interventional technique? Cardiovasc Intervent Radiol 2007; 31:336-41. [PMID: 17943346 DOI: 10.1007/s00270-007-9199-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Revised: 09/05/2007] [Accepted: 09/25/2007] [Indexed: 01/19/2023]
Abstract
Our aim in this study was to report our single-center experience with direct percutaneous jejunostomy over a 4-year period with regard to technical success rate, immediate and late complications, and patient tolerance of the procedure. Institutional records of 22 consecutive patients who underwent radiological insertion of a percutaneous jejunostomy for a variety of indications were reviewed. The proximal jejunum was punctured under either fluoroscopic or ultrasonic guidance, and following placement of retention sutures, a 10- to 12-Fr catheter inserted. There was a 100% technical success rate in placement involving a total of seven operators. The indications for placement were prior gastric resection, newly diagnosed resectable esophageal or gastric carcinoma, unresectable gastric carcinoma with outlet obstruction, and palliative drainage of bowel obstruction. Mean duration of follow-up was 100 days, and catheter placement 57.7 days. There were six minor early complications, consisting of loss of two retention anchors requiring repuncture, three cases of localized excessive postprocedural pain, and one failed relief of symptoms of small bowel obstruction. Four tubes developed late complications (two blocked, one catheter cracked, and one inadvertently pulled out). Three of the four were successfully replaced through the existing tracts. One patient subsequently developed a minor skin infection, while another developed late pericatheter leakage from ascites. We conclude that direct percutaneous jejunostomy is a valuable treatment modality applicable to a number of clinical scenarios, with a high technical success rate and low serious complication rate.
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Affiliation(s)
- Patrick Sparrow
- Department of Vascular and Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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Abstract
Percutaneous enteral access techniques are important tools in the armamentarium of the skilled endoscopist. Endoscopic and post-procedural complications of enteral access are not uncommon, and the increasing population of patients requiring long-term feeding tubes places even more emphasis on minimizing them. Most enteral feeding tube complications are minor, but several have the potential to cause significant morbidity and even mortality if not recognized and managed correctly. When complications do arise, early recognition and aggressive management are essential to optimize outcomes. Expertise with the proper patient selection, choice of feeding tube and insertion techniques are critical to minimizing endoscopic complications of percutaneous enteral feeding tubes.
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Affiliation(s)
- John C Fang
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 North 1900 East, Room 4R118, Salt Lake City, UT 84105, USA.
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Shike M. Predicting the success of percutaneous endoscopic jejunostomy placement: the endoscope light outshines the CT scan. Gastrointest Endosc 2006; 63:431-2. [PMID: 16500391 DOI: 10.1016/j.gie.2005.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 12/06/2005] [Indexed: 02/08/2023]
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Abstract
Enteral is preferred to parenteral nutritional support for acute and chronic diseases because it is more physiological and associated with fewer infection complications. Nasal tube feedings are generally used for 30 days or less and percutaneous access for the longer-term. Feeding by naso-gastric tubes is appropriate for most critically ill patients. However, trans-pyloric feeding is indicated for those with regurgitation and aspiration of gastric feeds. Deep naso-jejunal tube feeding is appropriate for patients with severe acute pancreatitis. There are several methods for endoscopic placement of naso-enteric tubes. Percutaneous endoscopic gastrostomy is used for most persons requiring long-term support. Long-term jejunal feeding is most often used for persons with chronic aspiration of gastric feeds, chronic pancreatitis intolerant to eating, or persons in need of concomitant gastric decompression. Percutaneous endoscopic gastrostomy with a jejunal tube extension is fraught with tube dysfunction and dislocation. Direct percutaneous endoscopic jejunostomy tubes may be more robust, but are less commonly performed.
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Affiliation(s)
- James A DiSario
- University of Utah Health Sciences Center, 30 North 1900 East, 4R 118, Salt Lake City, UT 84132, USA.
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