Laparoscopic Witzel feeding jejunostomy: a procedure overlooked!

Abstract

Purpose: Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart.

Methods: A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed.

Results: Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction.

Conclusion: Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.

Keywords: Enteral nutrition; Feeding; Jejunostomy; Laparoscopy; Minimally invasive surgery.

Fig. 1

(A) Port positions: camera 12-mm port and two 5-mm working ports. (B) Identification of duodenojejunal flexure. (C) Anchoring suture to the parietal wall. (D) Enterotomy of jejunum using harmonic scalpel. MCL, midclavicular line; AAL, anterior axillary line.

Fig. 2

(A) Nasogastric tube insertion through left 5-mm port. (B, C) Purse-string suture around nasogastric tube entry site. (D) Interrupted sutures for tunneling of tube.

Fig. 3

(A) Jejunum being fixed to parietal wall. (B) Three-point fixation of jejunum to the parietal wall.