Roux-en-Y Feeding Jejunostomy in Infants and Children

Abstract

Roux-en-Y jejunostomy (RYJ) permits enteral feeding in children unable to tolerate oral or intragastric feeds. It avoids many of the complications of nasojejunal and gastrojejunal tubes. Here we report our experience of intubated RYJ. By retrospective review of patient notes from 1998 - 2003, thirty-five children were identified. The median age was seven months (1 month - 16 years) and median follow-up was twenty-five months (1 - 55 months). There were no early postoperative complications or deaths. There were eighteen (51 %) late complications: peristomal leak (6), peristomal infection (2), bilious vomiting (5), tube displacement (3), abscess (1) and jejuno-colic fistula (1). Five children progressed to full oral feeds and had the RYJ resected. Fourteen of the twenty-eight children still alive remain fed by RYJ. Nine infants subsequently underwent fundoplication and gastrostomy with RYJ resection. Seven children died during the study period. RYJ is a straightforward procedure which can be performed safely in the face of poor nutrition and significant comorbidity. We recommend RYJ as a medium-term measure for enteral feeding.

Surgical jejunostomy and radiological gastro-jejunostomy tube feeding in children: risks, benefits and nutritional outcomes

“…Williams et al reported major complication rate of 37% [14] and Smith et al reported a major complication rate of 31% [15] with Roux-en-Y SJ. Taylor et al reported volvulus around Roux-en-Y SJ in 5 out of 25 patients (20% complication rate) [16].…”

Feeding Jejunostomy: Is It a Safe Route in Pediatric Patients? Single Institution Experience

“…1 It seems to improve the nutritional status and to decrease complications associated with reflux and parenteral nutrition. 1,2 Unfortunately, the literature around this nutritional technique is sparse, especially based on a limited number of patients and studies, with lacking attention to benefits (weight gain, parental satisfaction, incidence of aspiration pneumonia). 3 Some surgical techniques have been described for the insertion of a feeding tube into the jejunum with no significant difference in terms of effectiveness and complications' rate.…”

“…3 Some surgical techniques have been described for the insertion of a feeding tube into the jejunum with no significant difference in terms of effectiveness and complications' rate. 1,2,4,5 Major complications have been studied in this small case series.…”

Button-Loop Feeding Jejunostomy

“…4 Several studies have shown that enteral feeding via a surgical jejunostomy is safe in pediatric and adult patients requiring post-pyloric feeding. [4][5][6][7] Many surgical jejunostomy techniques have been proposed since the first feeding jejunostomy was documented in the literature in 1858. 8 The most common techniques used by surgeons, whether open or laparoscopic, include the Witzel and the Roux-en-Y techniques, each having certain drawbacks.…”

“…4,10 While these complications may be avoided by using the Roux-en-Y technique, this procedure is of longer duration and requires the creation of a jejuno-jejunal anastomosis. 5 At our institution, we practice a tube jejunostomy technique that we feel is simple and may reduce the risk of bowel obstruction without the need of a sewn anastomosis. In addition, this method utilizes a feeding button which is easily replaceable and comfortable for the patient.…”