Totally laparoscopic feeding jejunostomy - a technique modification.

Abstract

In oncological patients with upper gastrointestinal tract tumours, dysphagia and cachexy necessitate gastrostomy or jejunostomy as the only options of enteral access for long-term feeding. In this article the authors describe a modified technique of laparoscopic feeding jejunostomy applied during the staging laparoscopy. A 48-year-old male patient with gastroesophageal junction tumour and a 68-year-old male patient with oesophageal tumour were operated on using the described technique. Exploratory laparoscopy was performed. Then the feeding jejunostomy was made using a Cystofix® TUR catheter. The jejunum was fixed to the abdominal wall with four 2.0 Novafil™ transabdominal stitches. Two additional sutures were placed caudally about 4 cm and 8 cm from the jejunostomy, aiming at prevention of jejunal torsion. Total operating time was 45 min. There was no blood loss. There were no intraoperative complications. The only adverse event was one jejunostomy wound infection that responded well to oral antibiotics. There were no mortalities. The described technique has most of the benefits of laparoscopic feeding jejunostomy with some steps added from the open operation making the procedure easier to perform as part of a staging operation with a relatively short additional operating time. The proposed transabdominal stitches make the technique easier to apply. Two additional ‘anti-torsion sutures’ prevent postoperative volvulus. Use of the Cystofix catheter allows easy introduction of the catheter into the peritoneal cavity and the jejunal lumen, providing a good seal at the same time. Further studies on larger groups of patients are required to assess long-term outcomes of the proposed modified technique.

Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention

“…We believe the operation duration would be even shorter when the learning curve is overcome. Next, there is still a discrepancy between our operation duration and those of previous research [ 4 , 10 , 13 – 15 , 17 – 19 , 30 , 36 – 39 ]. We believe this is due to different definitions regarding operation time.…”

Surgical treatment of a rare case of granular cell tumour of the cervical oesophagus.

“…The gastrostomy was laparoscopy assisted. Laparoscopy feeding jejunostomy has also been reported previously [3]. The patient was then dismissed from the hospital.…”

Two port video-assisted gastrostomy and jejunostomy: technical simplification and clinical results

“…They are indicated when there is need for prolonged enteral feeding, which can be temporary or permanent. Can be performed by laparotomy, endoscopy, radiology, solely or combined laparoscopy and video-assisted laparoscopy 2 , 4 , 6 , 7 , 8 , 13 . They have great durability, do not cause discomfort to the airways, have good tolerance and social acceptability.…”