New Technique for Laparoscopic Jejunostomy Tube Placement

A novel trocar-guided approach offers an effective and timesaving surgical procedure for the laparoscopic placement of a feeding jejunostomy tube.

Developed by researchers at the University of California, Irvine (UCI; USA), City of Hope Hospital (Duarte, CA, USA), and Chonbuk National University Medical School (Jeonju, South Korea), the technique first involves the selection of an appropriate jejunal loop. Four vicryl sutures are then placed in a diamond shape on the antimesenteric side of the intestine, and left untied.

These four stitches are extracted using a transabdominal suture grasper inserted through four small incisions around the left lateral guide trocar. After an enterotomy is made in the center of the stitches using cautery device, the left lateral trocar is removed, and a 4 mm Foley catheter is inserted in the trocar site and introduced into the bowel. The four stitches are then pulled toward the abdominal wall and gently tied without additional suturing.

The developers reported the follow-up results in eight patients who underwent the procedure between 2007 and 2009. They found that the procedure was successful in all patients, with a median operative time of 70.5 minutes. There were no postoperative complications with respect to infection, bleeding, or bowel obstruction, and no perioperative mortality. The study describing the technique was published in the October 2012 issue of Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.

“Several techniques of laparoscopic feeding jejunostomy have been described. Most of them require costly commercial kits,” concluded lead author Rosa Jimenez Rodriguez, MD, PhD, of City of Hope Hospital, and colleagues. “Our trocar-guided approach for laparoscopic feeding jejunostomy placement is a simple, cost-effective, safe, and effective method.”

Jejunostomy is an alternative to gastrostomy when the stomach is unsuitable for a feeding tube, and refers to an artificial opening into the jejunum to allow the placement of a feeding tube. The procedure is usually performed endoscopically or via open surgery. Advantages over a gastrostomy include a lower risk of aspiration, while disadvantages include small bowel obstruction, ischemia, and requirement for continuous feeding.

Related Links:
University of California, Irvine
City of Hope Hospital
Chonbuk National University Medical School