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At least 19 recordsLinked to original sources
PubMed1992

A technique for converting a needle-catheter jejunostomy into a standard jejunostomy.

The benefits of enteral nutrition for surgical patients have been well documented in the literature, and needle catheter jejunostomy is frequently used at initial surgical exploration. Occasionally, the need arises for prolonged use of the catheter, and problems occur with occlusion of the catheter. A simple technique is described for converting the needle-catheter jejunostomy into a standard-feeding jejunostomy.

Catheters, Indwelling↗
PubMed1989

Jejunostomy button as a new method for long term jejunostomy feedings.

The button jejunostomy provides long term access for jejunal feedings incorporating the benefits of the gastrostomy button device. Although this procedure requires a celiotomy, we believe the relative simplicity of the procedure and its advantages over other types of jejunostomies warrant its use in patients with clinically significant gastroesophageal reflux who require long term enteral nutrition.

Adult↗
PubMed1987

Feeding jejunostomy (versus gastrostomy) passes the test of time.

The authors previously reported a higher incidence of early postoperative complications after feeding gastrostomy compared to jejunostomy, prompting the recommendation of jejunostomy for chronic enteral feeding. Long-term follow-up has since been obtained on these 31 patients and an additional 25 patients undergoing surgical feeding procedures. The 26 feeding gastrostomies were 16 Stamm, eight permanent mucosal-lined, and two Witzel. The 30 feeding jejunostomies consisted of 19 Roux-en-Y, nine Stamm, and two Witzel. Patients with gastrostomy have had a mean follow-up of 100 days. Adverse events have occurred in 15/26 (58%), including 9 patients with pulmonary aspiration (35%), two of which were fatal. Twenty-three additional patients have died of underlying diseases. All 11 patients with tube jejunostomy died of underlying diseases within 4 months of surgery. The complication rate was 36%, including pulmonary aspiration in both patients with Witzel jejunostomy. The 19 patients with Roux-en-Y jejunostomy have had mean follow-up of 169 days. Complications have occurred in 9 patients (47%); 16/19 patients (mean age 55 years) have died of underlying disease. The mean age of the patients still alive is 35 years. Feeding jejunostomy has a lower incidence of complications, especially pulmonary aspiration, than gastrostomy. Stamm jejunostomy should be used for enteral feeding in older patients and in patients with short life expectancy. In younger patients requiring lifelong enteral feeding, Roux-en-Y jejunostomy should be used.

Enteral Nutrition↗
PubMed1986

Jejunostomy. A rarely indicated procedure.

Jejunostomy is an alternative for alimentation in patients who cannot be fed orally. Seventy-three patients from the Medical College of Wisconsin Hospitals, Milwaukee, who underwent jejunostomy for gastrointestinal tract obstruction or dysfunction (28 patients), carcinoma (23 patients), neurologic disorders (13 patients), and other indications (nine patients) by the Stamm (46 patients), Witzel (17 patients), and Maydl (nine patients) techniques were studied. Forty-four patients survived and were discharged, while 29 died in the hospital. Fifty-three complications were documented among 34 patients. The jejunostomy was actually used for feeding in only 48 patients, and only 18 were discharged while receiving maintenance enterostomy feedings. Seven patients died as a direct result of complications of the jejunostomy. Jejunostomy is not an innocuous procedure; it carries a substantial risk of death and complications. Jejunostomy should be performed for alimentation only in patients with clear indications and a high potential for long-term use.

Adolescent↗
PubMed1988

Needle catheter jejunostomy: an unappreciated and misunderstood advance in the care of patients after major abdominal operations.

We evaluated the use of a needle catheter jejunostomy in 83 consecutive patients who underwent complicated abdominal operations. We used the needle catheter jejunostomy to deliver immediate postoperative nutrition (mean, 1,700 kcal/day) in 66 patients for a range of 4 to 80 days. In addition, the needle catheter jejunostomy was used to provide all maintenance fluid and electrolyte needs and to administer almost all required medications. No serious complications were related to use of the needle catheter jejunostomy, although easily controlled diarrhea occurred in 16 patients (19%). We concluded that the needle catheter jejunostomy is a safe and cost-effective means of delivering postoperative nutrition, fluid and electrolytes, and most medications in selected patients undergoing high-risk abdominal operations.

Adult↗
PubMedDate not supplied

Clinically significant pneumatosis intestinalis with postoperative enteral feedings by needle catheter jejunostomy: an unusual complication.

We evaluated the incidence of clinically significant pneumatosis intestinalis and intestinal necrosis with the use of needle catheter jejunostomy in 217 consecutive patients who had undergone complicated abdominal operations or selected bariatric procedures. The needle catheter jejunostomy was used to deliver immediate postoperative nutrition, maintenance, and replacement fluids, and selected medications. In this group, no serious complications requiring surgical intervention were related to the use of needle catheter jejunostomies. Clinically significant pneumatosis intestinalis was encountered in two of 217 patients (1%). With the needle catheter jejunostomy in place, both patients improved rapidly when enteral feedings were discontinued and parenteral antibiotics were administered. None of the 217 patients developed ischemic intestinal necrosis. We conclude that 1) clinically significant pneumatosis is a rare complication of enteric feeding via needle catheter jejunostomy when the intrajejunal feeding is begun with a diluted, hypoosmolar solution with stepwise increases in osmolality, and 2) patients who do develop clinically significant pneumatosis (n = 2) seem to respond rapidly to a temporary stoppage of enteral feedings and administration of parenteral antibiotics.

Catheterization↗
PubMed1979

Fine needle catheter jejunostomy--an assessment of a new method of nutritional support after major gastrointestinal surgery.

The results of our experience with the technique of fine needle catheter jejunostomy and early postoperative feeding through the catheter over a 12-month period are presented. Of the 43 patiening with an elemental diet without complications, 3 (7 per cent) were not fed for different reasons and 13 (30 per cent) developed complications that led to temporary or permanent cessation of the feeding. One patient in this group died of inhalation pneumonia. The voluntary food intake of 12 of the patients who were fed by jejunostomy after major colorectal surgery was assessed daily for 2 weeks after operation and compared with that of 12 control patients who did not have nutritional support. No significant difference in voluntary food intake was found between the two groups. The changes in body composition and plasma proteins and the clinical outcome of 20 of the patients fed by jejunostomy after major colorectal surgery were also compared with those of 20 matched controls. Body weight and lean body mass (as assessed by total body potassium and arm muscle circumference) and plasma prealbumin fell significantly in the control patients but not in those fed by jejunostomy. However, plasma transferrin decreased in both groups and there was no significant difference in clinical outcome in terms of complication rate or duration of postoperative hospital stay. The study would suggest that this technique of jejunostomy feeding should be reserved for selected cases where it may prove to be of real value, rather than being used routinely.

Aged↗
PubMed1987

Indications for needle catheter jejunostomy in elective abdominal surgery.

Needle catheter jejunostomy for postoperative nutritional support is now employed worldwide. However, there is a large discrepancy regarding indications for this technique which this study attempts to rectify. The need for nutritional support after elective abdominal procedures in 464 patients was analyzed and compared with the experience with needle catheter jejunostomy in 42 patients. The results show that needle catheter jejunostomy is indicated after extensive operations of the upper gastrointestinal tract, for example, esophagectomy, total gastrectomy, and the Whipple procedure. With minor upper gastrointestinal operations, or procedures of the lower gastrointestinal tract, needle catheter jejunostomy should be performed only in patients with poor nutritional status or in the presence of postoperative chemotherapy or radiotherapy. In an unclear situation, liberal insertion of the needle catheter jejunostomy and a postponed decision on enteral feeding is recommended, as there is no significant catheter-related morbidity.

Abdomen↗
PubMed1987

Immediate postoperative jejunostomy feeding. Clinical and metabolic results in a prospective trial.

A prospective clinical trial was designed to evaluate the efficacy of postoperative jejunostomy feedings using high (44 percent) and low (15 percent) branched-chain amino acid elemental diet formulations compared with no jejunostomy feedings in a homogeneous surgical population. Twenty-eight patients undergoing radical cystectomy and ileal diversion were randomized to the high branched-chain amino acid formula (11 patients) or the low branched-chain amino acid formula (9 patients). Eight patients received a 5 percent dextrose in water solution intravenously and served as a control group. Mean caloric intake per day in each group was 1,543 calories, 1,697 calories, and 550 calories, respectively; whereas the mean nitrogen intake of each group was 6.5 +/- 2.1 g/day, 8.2 +/- 2.4 g/day, and 0 g/day, respectively. Mean weight changes were minus 0.7 percent, 0.7 percent, and minus 0.3 percent, respectively. The mean daily nitrogen balance was minus 1.6 +/- 3.5 g/day, minus 1.1 +/- 4.4 g/day, and minus 6.6 +/- 1 g/day (p less than 0.001). Five patients (25 percent) in the jejunostomy groups progressed to an oral diet more rapidly than the control group, but gastrointestinal complications occurred in 11 patients (55 percent). Immediate postoperative jejunostomy feedings resulted in improved nitrogen balance compared with the control group values, but no metabolic advantage was noted by infusing a high branched-chain amino acid formula. Improved return to normal gastrointestinal function was noted in 25 percent of jejunostomy patients, but the gastrointestinal complications noted limited the overall usefulness of this technique.

Abdomen↗
PubMed1985

Comparison of needle catheter versus standard tube jejunostomy.

It is commonly stated that needle catheter jejunostomy (NCJ) is associated with fewer complications than standard tube jejunostomy (STJ). We compared the morbidity of NCJ versus STJ performed as adjunctive procedures in 90 patients from 1977 to 1983. NCJ was performed in 55 patients and STJ in 35 patients. The two groups were similar with respect to age, sex, diagnosis, and operation performed. The overall postoperative morbidity was 35 per cent for the NCJ group and 62 per cent for the STJ group. Mortality was 19 per cent and 35 per cent, respectively. Minor complications related to the jejunostomy occurred in 16 per cent of the NCJ group and 9 per cent of the STJ group. Diarrhea and abdominal distention occurred with equal frequency in the two groups. One NCJ patient required reoperation for intestinal obstruction at the catheter exit site, and one STJ patient required operative closure of a fistula following tube removal for major complications rates of 1.8 per cent and 2.8 per cent, respectively. The statement that STJ is associated with more jejunostomy-related complications than NCJ is not substantiated by this study. Because of greater ease of insertion, NCJ remains our procedure of choice for adjunctive feeding jejunostomy.

Catheterization↗
PubMedDate not supplied

Subcutaneous jejunostomy.

When the surgeon must obviate to an impending obstruction because of an unresectable tumor of the supramesocolic space and an intestinal bypass is not feasible, a jejunostomy is usually indicated. We describe a new method to provide enteral nutrition via a subcutaneous jejunostomy without any external device, which can be used only when the patient is at risk for developing an obstruction or dysphagia. The feeding tube is inserted into the jejunum and then connected to a Port-a-Cath lodged in a subcutaneous pocket. Subsequently, the nutrition can be delivered via a Huber needle inserted in the port, or, to minimize the need for strict aseptic surveillance, the tube can be exteriorized from the pocket and used as the usual tube jejunostomy. This procedure allows placing a precautionary jejunostomy without distortion of the body-image.

Enteral Nutrition↗
PubMed1990

[New material for needle jejunostomy: technique and preliminary results].

New material for needle jejunostomy was evaluated. They have the following advantages: rapidity and ease of use in jejunostomy, the possibility of a high daily calorie intake, a cutaneous fixation system allowing cleaning of the feeding tube stoma. The material is presented and the insertion technique is described. The preliminary results in 30 patients showed no mortality or morbidity related to the jejunostomy. The authors stress the importance of performing needle jejunostomy whenever long-term high calorie intake is required after the operation.

Digestive System Diseases↗
PubMed1990

A reproducible, safe jejunostomy replacement technique by a percutaneous endoscopic method.

Patients undergoing esophagogastrectomy for cancer often benefit from postoperative nutritional support and an operative jejunostomy is frequently placed at the time of surgery. If the original tube has been removed, replacement of this jejunostomy previously required repeat laparotomy. Described here is the technique of direct percutaneous endoscopic jejunostomy placement (PEJ) used in two such patients following esophagogastrectomy. This PEJ placement technique using a #16-Fr, Pezzer-type Ponsky tube is an easy, reproducible method for the replacement of an operative jejunostomy tube. The fibrosed tract between the abdominal wall and jejunum allows the safe performance of the procedure if one endoscopically identifies the site of operative insertion.

Esophagostomy↗
PubMed1992

Percutaneous replacement jejunostomy.

After esophagectomy in which a surgical jejunostomy is performed, there is a small group of patients whose jejunostomy tube has been removed who require late postoperative nutritional support. For these patients, a percutaneous replacement jejunostomy technique is described that is simple and safe and that allows for enteral alimentation.

Catheterization↗
PubMed1992

Surgical jejunostomy in aspiration risk patients.

One hundred patients underwent laparotomy for independent jejunal feeding tube placement. Neurologic disease was present in 50%, and obtundation (28) and oropharyngeal dysmotility (25) were the most common indications for enteral feeding. The post-pyloric route was chosen because of aspiration risk in almost all (94%) patients. Postoperative (30-day) mortality rate was 21%, because of cardiopulmonary failure in most (18). One death resulted directly from aspiration of tube feeds. Two surgical complications required reoperation: one wound dehiscence and one small bowel obstruction. Four wound infections occurred. Two patients underwent reoperation after tube removal, and four tubes required fluoroscopically guided reinsertion for peritubular drainage (2), removal (1), and occlusion (1). Aspiration pneumonia was present in 18 patients preoperatively and in eight postoperatively. None of the patients with feeding-related preoperative aspiration pneumonia (13) had a recurrence while fed by jejunostomy. Three patients developed postoperative aspiration pneumonia before initiation of jejunostomy feedings. Jejunostomy may be performed with low morbidity rate and substantial reduction of feeding-related aspiration pneumonia, and is the feeding route of choice in aspiration risk patients.

Adult↗
PubMed1990

Feeding jejunostomy: is its routine use in major upper gastrointestinal surgery justified?

An audit of jejunostomy feeding following major oesophagogastric surgery was carried out. The aim was to measure caloric and nitrogen intake, weight change, and to record complications. Twenty consecutive patients undergoing elective upper gastrointestinal surgery resulting in either an oesophagogastric or oesophagojejunal anastomosis were studied prospectively. In the eighteen cases whose catheters functioned, average calorie and nitrogen intake per day over the first 10 postoperative days was 1360 Kcal and 7.2 g respectively and average weight loss at 10 days was 1.3 kg. There was one major complication due to catheter dislodgement, resulting in an extraperitoneal abscess and subsequent small bowel fistula. In one other case the catheter was blocked from the immediate postoperative period and this could not be remedied. In the eighteen patients who were fed via the jejunostomy for 10 days, mild diarrhoea occurred in eight cases, but was easily managed. As experience with the technique increased, there was a significant increase in the amount of calories and nitrogen administered. This audit has demonstrated that provided care is taken with the technique of insertion of the jejunostomy catheter, satisfactory nutritional support can be provided in patients following oesophageal anastomoses with a low morbidity rate.

Anastomosis, Surgical↗