Feeding Jejunostomy: Is There Enough Evidence to Justify Its Routine Use?

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Abstract

Background and Aim: Intraoperative placement of feeding jejunostomy is a well-established method of providing access to enteral feeding. However, some studies describe serious complications related to this procedure. A retrospective study was undertaken to look at the technical complications related to the procedure. Patients and Methods: Patients undergoing feeding jejunostomy in the thoracic and upper gastrointestinal surgical units at the Royal Victoria Hospital between January 1998 and December 1998 were included in the study. The charts of all the patients were studied retrospectively. Results: Forty-two patients underwent a feeding jejunostomy in the time period studied. Thirty-one patients had a jejunostomy as an adjunct to major oesophageal or gastric surgery. In 5 patients, feeding jejunostomy was performed in conjunction with other palliative procedures and in 6 patients, it was performed as a sole procedure. Nine (21.4%) patients had procedure-related complications. Of these, 7 (16.7%) were minor including dislodgment of the tube (n = 4), blocked tube (n = 2), and intraoperative catheter damage (n = 1). Two (4.7%) patients had major complications requiring emergency laparotomy. One of these patients died as a result of a procedure- related complication. Conclusion: Feeding jejunostomy is associated with high morbidity and mortality. Its routine use may not be justified in the absence of evidence to support its use.

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Most cited references 2

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Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis.

Gurpreet Singh, R.Prashanth Ram, Satish K. Khanna (1998)

In our clinical setting, patients with perforative peritonitis are frequently malnourished. Immediate postoperative enteral feeding has been shown effective in reducing septic morbidity in patients with abdominal trauma. This study was designed to investigate the feasibility and efficacy of immediate postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. A prospective study spanning 1 year was conducted on patients with nontraumatic intestinal perforation and peritonitis. After laparotomy, patients were assigned randomly to a control or study group. The study group underwent a feeding jejunostomy and received enteral feeding from 12 hours postoperatively. A low-residue, milk-based diet was used. All patients underwent assessment for severity of sepsis and nutritional status at admission. Studies of nutritional status and nitrogen balance were repeated on days 4 and 7. Forty-three patients (21 in the study group; 22 in the control group) were included. The two groups were comparable except for a higher sepsis score in the study group (p < 0.05). Patients in the study group achieved a positive nitrogen balance by the third postoperative day; patients in the control group remained in negative nitrogen balance throughout the study. Abdominal distention (four patients) required temporary withdrawal of feeding. Diarrhea occurred in four patients but was controlled easily. The mortality rate was similar in the control and study groups (18.2% versus 19.1%). The control group had a total of 22 septic complications, versus eight in the study group (p < 0.05). Immediate postoperative feeding is feasible in patients with perforative peritonitis and reduces septic morbidity.

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Prophylactic jejunostomy: a reappraisal.

John Zapas, Stavros Karakozis, John R Kirkpatrick (1998)

The effectiveness of enteral feeding in maintaining postoperative nutrition has led some investigators to recommend prophylactic jejunostomy at the time of any high-risk abdominal operation. A failed procedure in this setting weighs heavily on the side of risk without identifiable benefit.

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Author and article information

Journal

Journal ID (publisher-id): DSU

Journal ID (nlm-ta): Dig Surg

Journal ID (doi): 10.1159/issn.0253-4886

Title: Digestive Surgery

Publisher: S. Karger AG

ISSN (Print): 0253-4886

ISSN (Electronic): 1421-9883

Publication date Subscription-year: 2004

Publication date (Print): March 2004

Publication date (Electronic): 18 June 2004

Volume: 21

Issue: 2

Pages: 142-145

Affiliations

The Royal Victoria Hospital, Belfast, Northern Ireland

Article

Publisher ID: 77454 Other ID: Dig Surg 2004;21:142–145

DOI: 10.1159/000077454

PubMed ID: 15044815

SO-VID: e74811d0-fe92-4fb5-ac7f-caa68e88a917

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 17 October 2003

Page count

Tables: 2, References: 18, Pages: 4

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