The Optimal Feeding Enterostomy Creation During Esophagectomy to Reduce the Long‐Term Risk of Small Bowel Obstruction

Abstract

Background Although feeding jejunostomy (FJ) is commonly created during esophagectomy for postoperative enteral nutrition, it can be a cause of postoperative small bowel obstruction (SBO). We introduced a technique of feeding enterostomy using the round ligament of the liver (FERL) to reduce SBO. In this study, we aimed to clarify the efficacy of FERL in reducing the postoperative SBO compared with FJ. Methods We assessed 400 consecutive patients who underwent esophagectomy with gastric tube reconstruction between 2011 and 2016, before and after the introduction of FERL (FJ, n = 200; FERL, n = 200). The cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy were compared between the FJ and the FERL groups. Results Thoracoscopic and laparoscopic surgery was more frequent in the FERL group than in the FJ group (p < 0.001). The cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy in the FERL group were significantly less frequent than those in the FJ group (p < 0.001 and p = 0.006, respectively). When stratifying by the abdominal surgical approach, the cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy in a laparoscopic approach were less frequent in the FERL group than those in the FJ group (both p < 0.001). Conclusions The FERL technique can reduce the incidences of postoperative SBO and SBO associated with feeding enterostomy in patients undergoing esophagectomy.

Long-Term Insufficiency of Oral Intake after Esophagectomy: Who Needs Intense Nutritional Support after Esophagectomy?

“…On the other hand, the nasoenteral tube could be displaced, externalized, and even obstructed, which would prevent its use as an enteral nutritional route [39]. In the feeding enterostomy, SBO or infectious complications related to the enterostomy sometimes occur [11][12][13][14]. Therefore, the route of nutrition should be selected on consideration of the risks of postoperative dysphagia, postoperative complications, and the possible duration of nutritional support following surgery into account.…”

“…Thoracic and abdominal procedures were performed using either an open or a minimally invasive approach. During esophagectomy, we routinely constructed feeding enterostomy using the round ligament of the liver to reduce SBO [13]. A feeding tube was inserted from the antrum of the gastric conduit or the duodenal bulb through the ligament, and the tip was placed in the third portion of the duodenum (online suppl.…”

“…Although the significance of postoperative enteral nutrition for the patients who underwent esophagectomy has shown conflicting results and the optimal route of enteral nutrition remains unclear [3][4][5][6][7][8][9][10][11], enteral tube feeding is commonly used for postoperative enteral nutrition. Feeding enterostomy allows home nutritional support easily for these patients, whereas middle-to longterm complications such as small-bowel obstruction (SBO) or infectious complications related to the enterostomy can develop [11][12][13][14]. On the other hand, noninvasive feeding access such as a nasoenteral tube might be sufficient for short-term perioperative nutritional support.…”

Ultra-Proximal Jejunostomy Application after McKeown-Type Esophagectomy: A Retrospective Case-Series Study

“…Catheter-related complications may be associated with jejunal fixation to the abdominal wall during fistulisation. Additionally, some scholars have proposed that the jejunal nutrient tube be led outside the abdominal wall via the round ligament of the liver during jejunostomy [4,5]. However, this technique, which does not require jejunal fixation of the abdominal wall, is not widely used in China.…”