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. 2021 Jan-Mar;17(1):127-130.
doi: 10.4103/jmas.JMAS_248_19.

Laparoscopic Witzel jejunostomy

Marco Lotti  1 , Michela Giulii Capponi  2 , Denise Ferrari  2 , Giulia Carrara  1 , Luca Campanati  2 , Alessandro Lucianetti  2
Affiliations

Laparoscopic Witzel jejunostomy

Marco Lotti et al. J Minim Access Surg. 2021 Jan-Mar.

Abstract

The placement of a feeding jejunostomy can be indicated in malnourished patients with gastric and oesophagogastric junction cancer to allow for enteral nutritional support. In these patients, the jejunostomy tube can be suitably placed at the time of staging laparoscopy. Several techniques of laparoscopic jejunostomy (LJ) have been described, yet the Witzel approach remains neglected, due to the perceived difficulty of suturing the bowel around the tube and securing them to the abdominal wall. Here, we describe a novel technique for LJ, using a single barbed suture for securing the bowel and tunnelling the jejunostomy catheter according to the Witzel approach.

Keywords: Enteral nutrition; gastric cancer; jejunostomy; laparoscopic jejunostomy; oesophagogastric junction cancer.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) Positioning of patient, (b) ports and (c) instruments
Figure 2
Figure 2
Preparation of the jejunostomy site. (a) Insertion of the trocar, (b) first bite, (c) anchorage of the suture, (d) second bite
Figure 3
Figure 3
Anchoring the selected jejunal loop to the abdominal wall. (a) First bite through the bowel, (b) first bite through the abdominal wall, (c) second bite, (d) securing the suture
Figure 4
Figure 4
Placement of the feeding tube. (a) Bowel incision, (b) inserting the tube through the trocar, (c) placing the tube and (d) guiding it into position
Figure 5
Figure 5
Starting with the tunnellisation. (a) Driving the needle through the bowel, (b) over the tube, (c) through the abdominal wall and (d) securing the suture
Figure 6
Figure 6
(a and b) proceeding with the tunnel, (c) completing the covering of the tube and (d) securing the bowel to the abdominal wall
Figure 7
Figure 7
The jejunostomy onsite
See this image and copyright information in PMC

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