Laparoscopic Feeding Jejunostomy Technique as Part of Staging Laparoscopy

Abstract

Placement of a feeding jejunostomy tube is indicated for patients who need enteral access but where a gastrostomy is not feasible. This paper presents the technique and results of laparoscopic placement of feeding jejunostomy tubes in patients presenting with esophagogastric cancer. From December 2002 to February 2004, patients diagnosed with esophagogastric cancer with a potentially resectable lesion underwent staging laparoscopy. Laparoscopic feeding jejunostomy was performed on patients who were potential candidates for chemotherapy with palliative intent or neoadjuvant treatment prior to resection surgery. Surgical technique, recovery of bowel function, commencement of feeding jejunostomy, total time tube was in situ, and perioperative complications were analyzed. Of the 22 patients who underwent staging laparoscopy, a feeding jejunostomy tube was placed in 18. The remaining 4 patients were deemed to have advanced disease precluding any therapeutic options and underwent placement of esophageal stents. Feeding tubes remained in situ for a median time period of 76 days. Fourteen patients required enteral support and tubes were used for a median of 30 days. Complications from tube placement included 2 cases of wound infections, 1 of minor leak and 1 tube dislodgment. Patients were followed up for a median time of 112 days. Findings from current series suggest that placement of a feeding jejunostomy tube at the time of staging laparoscopy is a safe and reliable means of providing and maintaining nutrition for patients presenting with esophagogastric cancers.

Expandable Polyester Silicon-Covered Stent for Malignant Esophageal Structures before Neoadjuvant Chemoradiation: A Pilot Study

“…Several studies have demonstrated the efficacy of a jejunostomy tube as a means of nutritional support in patients receiving neoadjuvant treatment [13,20,21]. However, there are potential complications for jejunostomy tube placement in these patients.…”

Laparoscopic T-tube feeding jejunostomy as an adjunct to staging laparoscopy for upper gastrointestinal malignancies: the technique and review of outcomes

“…Different techniques of anchoring the jejunum to the anterior abdominal wall have been described, either in the forms of transfascial sutures (transabdominal sutures [8, 10] or T-fasteners [5, 16]) or intracorporeal sutures [13, 17]. The transabdominal sutures (3–4 in number) are usually placed in a diamond configuration, incorporating the seromuscular layer of the jejunal wall and the anterior abdominal wall [6].…”

“…We compared our data and complication with 12 selected series in the literature that report on the outcomes of laparoscopic feeding jejunostomy (Table 2). The rate for conversion to open surgery ranges from 0 to 12.5% [11, 13], minor complications ranges from 5.3 to 32.1% [11, 20], major complications ranges from 0 to 10.7% [10, 11, 21] and mortality ranges from 0 to 11.1% [5]. The reported complications include wound infection [6, 22]; catheter dislodgement [6, 13, 23]; occlusion [13, 23]; pericatheter leak with generalized peritonitis [24]; aspiration pneumonia [22, 24]; small bowel necrosis [23, 25]; small bowel obstruction [13, 22, 23]; pneumatosis intestinalis [23, 26]; abdominal wall infection [13, 23]; fistula [13, 23]; volvulus [23]; and death [23, 25].…”

“…Major complications ( n  = 1, 4.3%): superficial abscess around the tube requiring I & D. One unrelated death.NMNo procedure related complications. A valuable addition to the surgeon’s options for obtaining enteral access.Grondona P et al [10]18Part of staging laparoscopy for esophagogastric cancerTotal laparoscopic using a dedicated feeding jejunostomy kitMinor complications ( n  = 3, 16.7%): tube dislodged ( n  = 1), leakage with wound infection ( n  = 1) & wound infection ( n  = 1). No major complications.NMA safe and reliable technique.…”

Staginglaparoskopie in der Onkologie

“…Möglicherweise wird hier die Immunzytochemie einen Fortschritt bringen [62]. Ganz sicher wird in Zukunft aber das (palliativ-)therapeutische Potenzial der Laparoskopie im direkten Anschluss an das Staging zunehmend mehr genutzt werden [29,67].…”