Feeding catheter gastrostomy with the round ligament of the liver prevents mechanical bowel obstruction after esophagectomy

Abstract

Jejunostomy, which requires the fixation of the jejunum to the abdominal wall, is commonly used as an enteral feeding access after esophagectomy. However, this procedure sometimes causes severe complications, such as mechanical bowel obstruction. In 2009, we developed a modified approach to insert an enteral feeding tube through the reconstructed gastric tube using the round ligament of the liver. The aim of this study is to investigate the usefulness of this approach as compared to the approach through jejunostomy. Between January 2005 and March 2015, 420 patients with thoracic esophageal cancer underwent esophagectomy via thoracotomy and laparotomy. Of these, 214 underwent feeding jejunostomy (FJ group) and 206 patients underwent feeding via gastric tube with round ligament of the liver (FG group). Catheter-related complications, other postoperative complications, and mortality were compared between the two groups. The incidence of catheter site infection during catheterization in the FG group was significantly lower (n = 1/206, 0.5%) compared to the FJ group (n = 11/214, 5.1%) (P < 0.01). The postoperative bowel obstruction did not occur in the FG group, while it occurred in eight patients (3.7%) in the FJ group (P < 0.01). The incidences of other catheter-related and postoperative complications were similar between the two groups. Feeding catheter gastrostomy with the round ligament of the liver can be a useful enteral feeding access after esophagectomy, because the incidence rate of severe catheter-related complications, such as surgical site infection and mechanical obstruction tend to be lower with this technique compare to jejunostomy.

Bowel obstruction associated with a feeding jejunostomy and its association to weight loss after thoracoscopic esophagectomy

“…In the previous report, laparoscopic procedure and fixation of the jejunum only at the catheter insertion point resulted in 11.5% of BOFJ [17]. On the other hand, open abdominal surgery and longitudinal fixation of the catheter resulted in less than 6.0% of BOFJ [18–20]. Judging from these, the reason of our high incidence of BOFJ might be fewer abdominal adhesion condition with laparoscopy and small area fixation suture around the catheter via a small abdominal incision, resulted in shorter distance between the catheter and midline, creating a large internal hernia space.…”

“…Despite the benefits of a feeding jejunostomy after esophagectomy, an alternative enteral feeding method would be desirable to avoid BOFJ. Some researchers have recommended insertion of the feeding catheter into the gastric tube [20, 22] or duodenum [23], through the round ligament of liver, rather than through the jejunum. However, insertion of a feeding catheter into the gastric tube requires a retro-sternum reconstruction.…”

Vertical distance from navel as a risk factor for bowel obstruction associated with feeding jejunostomy after esophagectomy: a retrospective cohort study

“…Recently, some researchers have recommended insertion of the feeding catheter into the duodenum [ 18 ] or gastric tube [ 20 , 22 ], through the round ligament of the liver, rather than through the jejunum to prevent BOFJ.…”

“…However, in patients with posterior mediastinal route reconstruction, constructing a feeding gastrostomy with round ligament is sometimes difficult because the location of gastric antrum is separate from the round ligament [ 22 ]. Another concern about duodenostomy has been inflammation around the duodenal bulb or pylorus following leakage and/or catheter-related abscess, leading to gastric tube stasis due to edema of the duodenum and/or pylorus [ 18 ].…”

Comparison of Feeding Jejunostomy via Gastric Tube Versus Jejunum After Esophageal Cancer Surgery

“…This is considered to cause twisting and kinking. Several authors reported that jejunal attachment to the parietal peritoneum may cause mechanical bowel obstruction at the catheter insertion site (7,8). As a new method to reduce complications, Oya et al and Kawai et al…”