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. 2020 Oct 27;20(1):354.
doi: 10.1186/s12876-020-01506-6.

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

Teppei Kamada  1 , Hironori Ohdaira  2 , Hideyuki Takeuchi  2 , Junji Takahashi  2 , Rui Marukuchi  2 , Eisaku Ito  2 , Norihiko Suzuki  2 , Satoshi Narihiro  2 , Sojun Hoshimoto  2 , Masashi Yoshida  2 , Mitsuyoshi Urashima  3 , Yutaka Suzuki  2
Affiliations

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

Teppei Kamada et al. BMC Gastroenterol. .

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.

Keywords: Bowel obstruction; Complications; Esophageal cancer; Esophagectomy; Feeding jejunostomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Measurement of straight-line distance (VD and HD) between the jejunostomy and navel performed from computed tomography (CT). a VD (dotted line arrow); b HD (solid line arrow)
Fig. 2
Fig. 2
Contrast-enhanced CT. Enhanced CT shows dilation of the proximal bowel from jejunostomy (arrows: button jejunostomy site)
Fig. 3
Fig. 3
Mechanisms in BOFJ. a, b Torsion + internal hernia pattern (TI pattern) torsion site (arrow), c adhesion + bending pattern (AB pattern). Obstruction site (arrow)
See this image and copyright information in PMC

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