Laparoscopic Jejunostomy: A simple valuable procedure

Introduction and Aims: Having Enteral feeding access is so valuable and critical for those patients with advanced upper gastrointestinal , orogharyngeal and laryngeal cancers who need to keep their caloric intake before surgery or during chemo-radiotherapy. Because of anatomic site of involvement ,this rout can not be accessed by endoscopic methods and minimally invasive procedures are the best options if could be performed within a short time and by simple methods. Methods: In a case series ,8 patients who needed feeding from enteral rout because of upper GI obstruction where selected. During a laparoscopic procedure and by a cystostomy catheter system, jejunostomy tube was placed for these patients. All patients had a 2 month follow-up for complications and performance of feeding system. Results: There was no internal leak and peritonitis among the subjects. 2 patients had external leak and 2 had extraction of catheter during follow-up period. None of them had peritonitis,wound infection and catheter obstruction. No significant bleeding was encountered during surgery. In one patient we change the procedure to open because of intestinal edema and stiffness and inadvertent bowel perforation by cystostomy catheter. One patient died after surgery because of cerebrovascular accident. Discussion: Laparoscopic Jejunostomy with this method is simple and can be done with acceptable time. Its pain is less than open procedure and better tolerated by patient. There was no serious intra-operative or post-operative complications in this procedure. The only limitations are patients that cannot be intubated and those with intra-abdominal adhesions or other problems that make the laparoscopy hard or impossible.

Keywords:

Jejunostomy , Laparoscopy , Enteral nutrition