Ericka Sohlberg, BS, Samuel Garbus, BS, James Dolan, MD, Brett Sheppard, MD, John Hunter, MD, Erin Gilbert, MD. Oregon Health & Science University
Introduction: Laparoscopic jejunostomy tube (J-tube) placement has become a routine method to provide enteral nutrition for patients who are otherwise unable to tolerate oral intake. The reported complication rate related to placement of J-tubes or their post-operative function varies dramatically from 5-25%. There is a paucity of recent studies that evaluate the morbidity of this procedure. Consequently, our primary objective was to evaluate the morbidity rate of laparoscopic J-tube placement at our center and to identify risk factors for morbidity in patients undergoing laparoscopic J-tube placement.
Methods and Procedures: A retrospective review was performed on all patients who underwent recent laparoscopic J-tube placement at a single academic center between January 2010 and December 2013. Patients were identified in administrative data using the CPT code 44186. Logistic regression models were used to estimate the association of J-tube complications with both demographic and clinical variables. Multivariate analysis was performed to determine the combined effect of significant predictors on outcomes and is expressed as the adjusted odds ratio (OR) with 95% confidence interval.
Results: 148 patients were identified. The majority (73%) was male with a median age of 63 years (range 25-86). Most underwent laparoscopic J-tube placement in the setting of a cancer diagnosis (85%). The procedure was either conducted alone (53%), or in combination with an elective procedure (43%) or an urgent procedure (3%). The overall complication rate was 55% with 28% (n=42) of patients having one or more J-tube specific complications including dislodgement (81%), obstruction (21%), superficial infection (24%), bowel perforation (2%) and bowel obstruction (2%). The overall reoperation rate was 27%. Of the 23% (n=34) with the complication dislodgement, 6 required operative revision. After controlling for age, indication, procedure category, BMI, smoking history and pre-operative albumin only the diagnosis of type II diabetes was a significant predictor of J-tube complication [OR=3.5 (1.4-8.4)].
Conclusions: Although the benefits of J-tube placement for enteral nutrition are well established, the morbidity from the procedure is less known. At our high volume, tertiary care center, post-operative morbidity was high and reoperation was necessary in almost one third of patients. In addition, complication after J-tube placement was significantly associated with a diagnosis of diabetes. Based on this experience we conclude that many complications could be prevented by a more secure fixation technique. This technique has already been adopted at our center with a resultant improvement in the morbidity rate related to the procedure.