Prophylactic jejunostomy: a reappraisal.

J L Zapas; S Karakozis; J R Kirkpatrick

doi:10.1067/msy.1998.92380

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PubMed · 9780993

Prophylactic jejunostomy: a reappraisal.

J L Zapas·S Karakozis·J R Kirkpatrick

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Abstract

BACKGROUND: 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. METHODS: A benefit/risk analysis comparing complication rate, avoidance of parenteral nutrition, and discontinuation of jejunostomy feeding was performed in 92 patients. These patients were judged retrospectively to be undergoing either a prophylactic jejunostomy placed at the time of operation for another serious condition (group A) or therapeutic jejunostomy alone (group B) during a 3-year period (1993 to 1996). Classification as prophylactic or therapeutic was determined by the surgeon's preoperative intent. RESULTS: Avoidance of parenteral nutritional support, a goal of prophylactic jejunostomy, was not achieved in 39% of the patients. Patients in group A had a 5-fold increase in the risk of premature discontinuation of enteral feeds when compared with group B (P < .03). The complication rate was higher in group A (41%) than in group B (26%). Four life-threatening complications occurred in group A; all required reversal of the feeding jejunostomy. CONCLUSIONS: This study suggests that the benefit/risk ratio of prophylactic jejunostomy is low. This adds weight to the notion that this procedure be abandoned in favor of other forms of nutritional support.

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Adolescent Adult Aged Aged, 80 and over Enteral Nutrition Female Humans Jejunostomy Male Middle Aged Preoperative Care Retrospective Studies Risk Factors Treatment Outcome Journal Article

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J L Zapas, S Karakozis, J R Kirkpatrick. 1998. Prophylactic jejunostomy: a reappraisal.. https://doi.org/10.1067/msy.1998.92380

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