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

Abstract

Background Placement of feeding jejunostomy (PFJ) during esophagectomy is an effective method to maintain adequate nutrition, but is associated with serious complications such as bowel obstruction and jejunal torsion. The purpose of the current study was to analyze the incidence, clinical features, and risk factors of bowel obstruction associated with feeding jejunostomy (BOFJ) after PFJ. Methods This was a retrospective cohort study of 70 patients who underwent esophagectomy with three-field lymph node dissection for esophageal cancer and treated with PFJ between March 2013 and December 2019 in our hospital. Abdominal dissection was performed under hand-assisted laparoscopic surgery (HALS) from March 2013 to March 2015, and was changed to complete laparoscopic surgery in April 2015. We compared patients with and without BOFJ, and the incidence of BOFJ was evaluated. The primary endpoint was incidence of BOFJ after PFJ. Results Six patients (8.5%) were diagnosed with BOFJ, all of whom were symptomatic and in the HALS group. In addition, 3 cases displayed histories of recurrent BOFJ (3, 3, and 5 times). Laparotomy was performed in all cases. Subgroup analysis of the HALS group showed a significant difference only in straight-line distance between the jejunostomy and navel as a significant pre- and perioperative factor (117 mm [101–130 mm] vs. 89 mm [51–150 mm], p < 0.001). Furthermore, dividing straight-line distance between the jejunostomy and navel into VD and HD, only VD differed significantly (107 mm [93–120 mm] vs. 79 mm [28–135 mm], p = 0.010), not HD (48 mm [40–59 mm] vs. 46 mm [22–60 mm], p = 0.199). Conclusions VD between the jejunostomy and navel was associated with BOFJ after PFJ with HALS esophagectomy. PFJ < 9 cm above the navel during HALS esophagectomy might effectively prevent BOFJ.

Benefit of a laparoscopic jejunostomy feeding catheter insertion to prevent bowel obstruction associated with feeding jejunostomy after esophagectomy

“…BOFJ is caused by the small intestine torsion of the anal side over the jejunostomy into the gap between the abdominal wall fixation sites. Kamada et al 14 reported that the vertical distance between the jejunostomy and navel was associated with BOFJ. We also reported that the proximity of the jejunostomy to the midline of the abdomen is a risk factor for BOFJ 8 and that the risk of torsion due to internal herniation into the gap and strangulation may increase depending on the position of the jejunostomy site.…”

Benefit of a laparoscopic jejunostomy feeding catheter insertion to prevent bowel obstruction associated with feeding jejunostomy after esophagectomy

“…BOFJ is caused by torsion of the anal side of the small intestine into the gap between the catheter insertion site and the abdominal wall xation site. Kamada et al [14] reported that the vertical distance between the jejunostomy and navel was associated with BOFJ.…”

Risk factors for refractory enterocutaneous fistula following button jejunostomy removal and its treatment using a novel extraperitoneal approach in patients with oesophageal cancer: a retrospective cohort study

“…In addition, ‘free distal flow’ has been reported as an important factor in spontaneous closure [ 11 ]. Button jejunostomy has an acute bending angle between the jejunostomy and abdominal wall compared with Wizel jejunostomy [ 6 ], which may interfere with the natural flow of intestinal fluid to the distal intestinal tract and lead to REF.…”

“…Button jejunostomy was performed in the same method in all patients during oesophagectomy. The details of button jejunostomy creation were described in a previous report [ 6 ]. We inserted a 24-Fr button-type catheter (IDEAL BUTTON®; Olympus Medical Systems Co.Ltd, Tokyo, Japan) to the jejunum.…”

“…Feeding jejunostomy is a common pathway for enteral nutrition after oesophagectomy, and it is not uncommon to require enteral nutrition by feeding jejunostomy for a long time, not only in the peri-operative period but also for anorexia and weight loss due to recurrences and chemotherapy adverse events [ 2 , 3 ]. However, serious complications of feeding jejunostomy, such as bowel obstruction, abdominal wall infection, tube deviation, and peritonitis owing to fistula injury during replacement, have been reported [ 4 – 6 ]. In particular, enterocutaneous fistula after removal of the jejunostomy tube leads to multiple problems, such as cosmetic problems, decreased quality of life, electrolyte imbalances, infectious complications, and increased medical costs.…”