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Comparative Study
. 2021 Jan 13;21(1):37.
doi: 10.1186/s12893-021-01050-4.

Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention

Hsin-I Tsai  1   2   3 , Ta-Chun Chou  4 , Ming-Chin Yu  2   3   5   6 , Chun-Nan Yeh  2   5 , Meng-Ting Peng  7 , Chia-Hsun Hsieh  2   7   8 , Po-Jung Su  2   7   9 , Chiao-En Wu  2   7 , Yung-Chia Kuo  2   3   7 , Chien-Chih Chiu  10 , Chao-Wei Lee  11   12   13
Affiliations
Comparative Study

Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention

Hsin-I Tsai et al. BMC Surg. .

Abstract

Background: Laparoscopic procedure has inherent merits of smaller incisions, better cosmesis, less postoperative pain, and earlier recovery. In the current study, we presented our method of purely laparoscopic feeding jejunostomy and compared its results with that of conventional open approach.

Methods: We retrospectively reviewed our patients from 2012 to 2019 who had received either laparoscopic jejunostomy (LJ, n = 29) or open ones (OJ, n = 94) in Chang Gung Memorial Hospital, Linkou. Peri-operative data and postoperative outcomes were analyzed.

Results: In the current study, we employed 3-0 Vicryl, instead of V-loc barbed sutures, for laparoscopic jejunostomy. The mean operative duration of LJ group was about 30 min longer than the OJ group (159 ± 57.2 mins vs 128 ± 34.6 mins; P = 0.001). There were no intraoperative complications reported in both groups. The patients in the LJ group suffered significantly less postoperative pain than in the OJ group (mean NRS 2.03 ± 0.9 vs. 2.79 ± 1.2; P = 0.002). The majority of patients in both groups received early enteral nutrition (< 48 h) after the operation (86.2% vs. 74.5%; P = 0.143).

Conclusions: Our study demonstrated that purely laparoscopic feeding jejunostomy is a safe and feasible procedure with less postoperative pain and excellent postoperative outcome. It also provides surgeons opportunities to enhance intracorporeal suture techniques.

Keywords: Enteral nutrition; Enterostomy; Feeding; Jejunostomy; Minimally invasive surgery; Purely laparoscopic.

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Conflict of interest statement

Hsin-I Tsai, Ta-Chun Chou, Ming-Chin Yu, Chun-Nan Yeh, Meng-Ting Peng, Chia-Hsun Hsieh, Po-Jung Su, Chiao-En Wu, Yung-Chia Kuo, Chien-Chih Chiu, and Chao-Wei Lee have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Operation room settings and the placement of trocar ports. a The patient was placed in supine position. The procedures were performed by two surgeons, with the index operating surgeon and camera man standing on the right side of the patient. b The video laparoscope was introduced via a 5 mm vertical incision at about 3 cm below the umbilicus. Another 5 mm working port was created below the umbilical level at around left mid-clavicular line. The third 5 mm working port was created slightly above the umbilical level at right paramedian area
Fig. 2
Fig. 2
Stepwise procedures of laparoscopic feeding jejunostomy. a Two fixation stiches were made between the peritoneal surface of the cutaneous exit and the proximal jejunum, which was usually about 15 to 20 cm distal to the Treitz ligament. A small enterotomy was made by monopolar electrocautery at an appropriate location just opposite to the cutaneous exit. b A skin incision was made at the predetermined cutaneous exit and one 14Fr feeding tube was inserted through this incision into the distal jejunum. The tube was advanced to a designated length and one purse-string sero-muscular suture around the tube was performed. c Several more interrupted peritonization sutures were carried out to approximate the jejunum to the peritoneal side of the anterior abdominal wall. d The feeding tube was finally tested for patency and leakage after these procedures
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