Blade-Directed Totally Laparoscopic Feeding Jejunostomy – How to do it
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 7, Issue 1
Abstract
Jejunostomy is the recommended route for enteral nutrition in certain patients. Various methods and equipment had been proposed to complete the operation laparoscopically. The method we proposed is based on the triangular rule of trocar orientation with typically available tube and equipment. It minimized the wounds to one 11mm trocar for the laparoscope plus two 5mm trocars for intracorporeal suturing, by creating the jejunostoma with straightforward surgical blade penetration. Sixty-nine patients underwent the operation as either a solitary procedure or a part of the operation based on preoperative indications. The majority of the patients received feeding within 3 day after operation (84%) without major complications. Fifteen patients experienced tube dislodgement or occlusion during the follow up but did not encounter difficulty while exchanging new tubes. The method we proposed could be done with readily available equipment and minimized wounds and did not yield major complications.Enteral nutrition routes exhibit advantages over parenteral routes. Based on the clinical scenario, enteral feeding can be provided through gastrostomy or jejunostomy either endoscopically or surgically generated. However, debate remains regarding the choice of enterostomy, and jejunostomy is preferred to gastrostomy in certain conditions, particularly when the stomach is to be reserved for subsequent reconstruction. Since the first reported totally laparoscopic feeding jejunostomy [1], various methods had been proposed with acceptable results [2-5]. These methods require either specific equipment or modified tubes that increased excessive cost. Small wound is a major advantage of laparoscopic operation compared with conventional laparotomy, particularly when treating malnourished patients who are at risk of impaired wound healing. We make every effort to minimize the wounds. Our proposed method is based on the triangle rule of orientation of trocars and the revision of conventional totally laparoscopic feeding jejunostomy. We then create the insertion site of the tube by straightforward penetration with surgical blade under laparoscopy. After each fixation of peritonization, the needle could be extracted via the 5mm trocars. With the above two maneuvers, totally laparoscopic feeding jejunostomy could be completed with one 11mm trocar plus two 5mm trocars by intracorporeal sutures with typically available equipment.The patients were placed in the Trendelenburg position at 30° and tilted to the left side. The surgeon stood at the right cephalic side of the patient, and the assistant stood at the right caudal side. We applied a 11mm trocar through the umbilicus for the laparoscope. Then the two 5mm working ports were created: one is at the lower midline 10 cm from the umbilicus and the other is at the left subcostal area 10 cm from the umbilicus (Figure 1). The orientation of the trocars and the presumed jejunostoma conformed to the “triangle rule”, ensuring a smooth operation.
Authors and Affiliations
Chun Chih Lai, Chun Yi Tsai, Chun Nan Yeh
Keywords
Related Articles
- EP ID EP588539
- DOI 10.26717/BJSTR.2018.07.001457
- Views 137
- Downloads 0
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