Luis Felipe Okida, MD, Tara Salimi, Francisco Ferri, MD, Juliana Henrique, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
BACKGROUND: Feeding jejunostomy is an alternative route of enteral nutrition in patients undergoing major gastrointestinal operations, unable to achieve nutritional support per os, or when a feeding gastrostomy is not suitable. Data regarding this type of enteral feeding and related complications are crucial to analyze its safety, but still limited in the literature. The current study aims to analyze complications after feeding jejunostomy placement.
METHODS: A single-institution review of patients who underwent open or laparoscopic jejunostomy tube (JT) placement between 2009 and 2019 was performed. Data collected included demographics, preoperative serum albumin, surgery indication, concomitancy of procedure, size of JT tube and time to its removal. JT complications were analyzed in the early postoperative period (< 30 days) and in a long-term follow-up (> 30 days), as well as mortality. The chi-square test was used to compare rates of complications according to tube size and statistical significance was considered if p-value < 0.05.
RESULTS: Seventy-three patients underwent JT placement, and gastroesophageal cancer (n=48, 66%) was the most common indication. The JT was most frequently placed concomitantly (n=56, 77%) to the primary operation and through a laparoscopic approach (n=66, 90%). A total of 14 patients (19%) had early complications and 15 had late complications (21%). The reasons for early complications were clogged JT (n=8, 10.9%), JT dislodgement (n=3, 4.1%), leakage (n=2, 2.7%), small bowel obstruction at the site of the jejunostomy tube (n=2, 2.7%), JT site infection (n=1, 1%), and intraperitoneal JT displacement (n=1.3, 1%). The reasons for late complications were clogged JT (n=6, 8%), JT dislodgement (n=6, 8%), JT site infection (n=3, 4%), and JT leakage (n=1, 1%). There was no procedure-related mortality in this series. However, twelve patients (16%) died due to their baseline disease. The mean time to tube removal was 83 ± 93 days. The most frequently used JT sizes were 14 French (Fr) (n=35%) and 18Fr (n=13%), but in nine patients (12%) the tube size was not reported. No statistical significance (p=0.75) was found when comparing the two most commonly used sizes to rates of complications.
CONCLUSION: The rate of JT complications in our study is comparable to other published reports in the literature. The procedure appears to be safe and feasible despite the number of complications. Therefore, this approach should be indicated to ensure the optimization of nutritional status for patients with complications that require prolonged periods of time without nutritional support per os.
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This abstract was accepted for Poster presentation at the 2020 SAGES Virtual Meeting in the Foregut topic. Its program number was: P402 and its Abstract ID was: 102025