Laparoscopic vs. open feeding jejunostomy insertion in oesophagogastric cancer

Abstract

Background Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. Methods A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. Results In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs. 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). Conclusions This report represents the largest to our knowledge single-centre comparison of open vs. laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

Untitled

“…Both lower thoracic spinal nerves and celiac plexus carries nociceptive somatic and visceral afferent inputs of the corresponding areas which these innervates [16]. Feeding jejunostomy involves mini laparotomy through a midline incision between T7 to T9 dermatomes in the anterior abdominal wall followed by enterotomy and fixation of a feeding tube inside the jejunal loop [17]. Hence, we have used SC TAP block to block the T6 to T10 spinal nerves to facilitate anterior abdominal wall manipulation and CP block to facilitate bowel handling during feeding jejunostomy.…”

Laparoscopic jejunostomy for enteral nutrition in gastric cancer patients: A report of two cases: A case report

“…For patients with advanced unresectable gastric cancer with dyspepsia, a laparoscopic jejunostomy may be an option for treatment. In a retrospective study, it was reported that there were fewer postoperative complications with laparoscopic jejunostomy than with the open approach [13] . Especially in advanced gastric cancer, the results of the JLSSG0901 study showed that laparoscopic surgery is not inferior to open surgery; thus, the percentage of laparoscopic gastric cancer surgery is expected to increase in the future.…”

Laparoscopic Witzel feeding jejunostomy: a procedure overlooked!

“…In contrast to open FJ, laparoscopic Witzel technique for FJ has limited reports in the literature and has not been discussed widely as a standalone procedure. Furthermore, LFJ by Stamm technique is also preferred at many centers but is associated with many complications [1,4]. Hence, there is a definite need to discuss the technical aspect of LFJ and its outcomes in detail.…”