Totally laparoscopic feeding jejunostomy – a technique modification

Maciej Bobowicz; Wojciech Makarewicz; Tomasz Polec; Arkadiusz Kopiejć; Tomasz Jastrzębski; Jacek Zieliński; Janusz Jaśkiewicz

doi:10.5114/wiitm.2011.26262

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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4/2011
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abstract:

Case report

Totally laparoscopic feeding jejunostomy – a technique modification

Maciej Bobowicz

,

Wojciech Makarewicz

,

Tomasz Polec

,

Arkadiusz Kopiejć

,

Tomasz Jastrzębski

,

Jacek Zieliński

,

Janusz Jaśkiewicz

Videosurgery and Other Miniinvasive Techniques 2011; 6 (4): 256-260

DOI: https://doi.org/10.5114/wiitm.2011.26262

Online publish date: 2011/12/20

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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.

keywords:

Totally laparoscopic feeding jejunostomy – a technique modification

Maciej Bobowicz , Wojciech Makarewicz , Tomasz Polec , Arkadiusz Kopiejć , Tomasz Jastrzębski , Jacek Zieliński , Janusz Jaśkiewicz

feeding microjejunostomy, enteral feeding, laparoscopy, minimally invasive surgery, technique modification, oncology

Maciej Bobowicz

,

Wojciech Makarewicz

,

Tomasz Polec

,

Arkadiusz Kopiejć

,

Tomasz Jastrzębski

,

Jacek Zieliński

,

Janusz Jaśkiewicz