Ciara R Huntington, MD1, Ryan C Pickens, MD2, Thomas R Huntington, MD1. 1Huntington Laparoscopy, 2Atrium Health / Carolina Medical Center
Feeding jejunostomy tubes are a critical means of enteral nutritional support for patients who have foregut pathology. All surgeons should feel comfortable with placement of feeding jejunostomy tube – yet, many surgeons resort to an open approach due to the perceived difficulty of a laparoscopic approach including suturing and securing the tube. Surgeons who employ open techniques often utilize the Witzel approach, where the tube is secured by suturing bowel around the tube and then to the abdominal wall. The Witzel tube placement minimizes leaks and complications by placing the exit to the skin far from the entrance of the tube into the bowel. In this video, we present a laparoscopic Witzel approach for placement of feeding jejunostomy tube.
This approach combines the advantages of the traditional Witzel technique with the superb visualization and fast recovery of laparoscopy. To perform the technique, loop of jejunum is selected 30-40cm from the Ligament of Treitz. A laparoscopic stay stitch secures the bowel to the anterior abdominal wall. The use of an external knot pusher allows the laparoscopic surgeon to keep tension on the knots and move through the operation efficiently –however, internal knot tying can also be used if desired. An introducer needle is tunneled through the muscular layer of the distal limb of jejunum into the lumen; position is tested by insufflating the lumen with a syringe full of air. Next, the guide wire followed by jejunostomy tube are introduced into distal bowel. Using laparoscopic vicryl stitches, the laparoscopic Witzel is now performed with 3-4 stitches. A “bite” is taken from the bowel on one side of the tube, then the bowel on the other side of the tube, and finally the needle is passed through the abdominal wall. This allows small bowel to cover the tube and be fixed firmly to the abdominal wall. This is repeated until the tube is completely covered. Care is taken not to incorporate the tube into the stitches. The balloon is inflated with 3ml sterile water, and the jejunostomy tube is tested and checked. This technique allows for placement of efficient and secure distal feeding access, incorporating the surgical technique of tried-and-tested open approach into the minimally invasive setting.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95771
Program Number: V239
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop