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PubMed1998

Prophylactic jejunostomy: a reappraisal.

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.

Adolescent↗
PubMed2004

Relaparotomy following complications of feeding jejunostomy in esophageal surgery.

BACKGROUND: After recognition of the importance of early postoperative enteral feeding, placement of a feeding jejunostomy as an adjunct to gastrointestinal surgery has become widely accepted. However, little attention has been paid to surgical complications and their consequences. Feeding jejunostomy as an adjunct to esophageal resection and reconstruction can lead to serious surgical complications. METHODS: Between 1978 and 2000, 1,387 patients underwent esophageal resection and reconstruction. Of these, 1,166 patients received a needle catheter feeding jejunostomy at the end of the operation. All postoperative complications were prospectively evaluated in a database including surgical complications related to the feeding jejunostomy. RESULTS: Overall, surgical complications occurred in 36%. There were 13 (1.1%) feeding jejunostomy related complications leading to relaparotomy. Of these, intraperitoneal leakage was the most common complication (n=5). Other jejunostomy-related complications included dislodgement (n=4), herniation (n=3) and torsion (n=1). Five patients (0.4%) died despite relaparotomy. CONCLUSIONS: Feeding jejunostomy as an adjunct to esophageal resection and reconstruction can lead to serious surgical complications. Preventive measures have not resulted in a decrease in complication rate. Complications of leakage necessitating relaparotomy are associated with a high mortality rate. Therefore, other means of enteral access should be considered.

Enteral Nutrition↗
PubMed1999

Jejunostomy: techniques, indications, and complications.

Jejunostomy is a surgical procedure by which a tube is situated in the lumen of the proximal jejunum, primarily to administer nutrition. There are many techniques used for jejunostomy: longitudinal Witzel, transverse Witzel, open gastrojejunostomy, needle catheter technique, percutaneous endoscopy, and laparoscopy. The principal indication for a jejunostomy is as an additional procedure during major surgery of the upper digestive tract, where irrespective of the pathology or surgical procedures of the esophagus, stomach, duodenum, pancreas, liver, and biliary tracts, nutrition can be infused at the level of the jejunum. It is also used in laparotomy patients in whom a complicated postoperatory recovery is expected, those with a prolonged fasting period, those in a hypercatabolic state, or those who will subsequently need chemotherapy or radiotherapy. As a sole procedure it is advised for neurologic and congenital illnesses, in geriatric patients who pose difficult care demands, and for patients with tumors of the head and neck. The complications seen with jejunostomy can be mechanical, infectious, gastrointestinal, or metabolic. The rate of technical complications of the Witzel longitudinal technique is 2.1%, for the transverse Witzel up to 6.6%, for the Roux-en-Y 21%, for open gastrojejunostomy from 2%, and for the needle catheter technique from 1.5% with 0.14% mortality. The percutaneous endoscopic procedures have as much as a 12% complication rate; no figures exist for laparoscopy. The complications are moderate and severe: tube dislocation, obstruction or migration of the tube, cutaneous or intraabdominal abscesses, enterocutaneous fistulas, pneumatosis, occlusion, and intestinal ischemia. The infectious complications are aspiration pneumonia and contamination of the diet. The gastrointestinal complications are diarrhea 2.3% to 6.8%, abdominal distension, colic, constipation, nausea, and vomiting. The metabolic complications are hyperglycemia 29%, hypokalemia 50%, water and electrolyte imbalance, hypophosphatemia, and hypomagnesemia. These complications are secondary to inadequate selection of nutrition relative to the characteristics of the patient, to inadequate management of the mixture, and to deficient clinical care. The ideal jejunostomy technique depends on the material resources but more importantly on the experience of the surgeon. The benefits of jejunostomy justify the risks.

Aged↗
PubMed2005

Laparoscopic-assisted jejunostomy: an effective procedure for the treatment of neurologically impaired children with feeding problems and gastroesophageal reflux.

BACKGROUND: Feeding difficulties and gastroesophageal reflux (GER) are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients. METHODS: Since January 2002, seven patients (age range, 5-14 years) have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using two 10-mm trocars. The technique consists of identifying the first jejunal loop, grasping it 20-30 cm away from the Treitz ligament with fenestrated atraumatic forceps, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct positions of the intestinal loop and feeding tube were evaluated via laparoscopy. RESULTS: Surgery lasted 40 min on average, the laparoscopic portion only 5 min. There were no perioperative complications; hospital stay was 3 or 4 days for all patients. At the longest follow-up (18 months), all patients had experienced a significant weight gain, with a high level of parental satisfaction. One patient died 1 year after the procedure of unknown causes. All the others are well, without complications or problems, and their parents are extremely satisfied with the improved quality of life of their children. CONCLUSIONS: Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. This procedure solves these patients' feeding problems even if the reflux is not completely eliminated. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. This technique is extremely safe because the surgeon is able to verify, at the end of procedure, the status of the jejunostomy from outside and inside the abdominal cavity. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure.

Adolescent↗
PubMed2005

[Enteral nutrition with needle catheter jejunostomy in esophageal anastomosis. Complications of the technique].

OBJECTIVE: The aim of this study was to evaluate the presence of complications associated with the use of surgical needle catheter jejunostomy and tolerance to enteral nutrition. PATIENTS AND METHOD: We performed a retrospective study of 58 consecutive patients, who underwent esophageal or gastric resection with esophageal anastomosis and needle catheter jejunostomy. The variables studied were initiation of enteral nutrition, duration of perfusion, complications associated with the use of jejunostomy, and tolerance to enteral nutrition. RESULTS: Mortality in the series was 1.7%. Infusion of enteral nutrition was started at mean of 4.84+/-5.01 days and lasted for a mean of 7.9+/-7.5 days. In one patient the jejunostomy could not be used due to catheter obstruction and in another 2 patients some resistance to perfusion of nutrition was observed but these patients could be fed through the tube. One patient had to undergo reintervention due to peritonitis caused by extravasation of the enteral nutrition within the peritoneal cavity. Catheter withdrawal was difficult in 2 patients; of these, 1 patient required investigation of the skin wound under local anesthetic. The overall rate of jejunostomy-related complications was 10.3%. Tolerance of enteral nutrition was acceptable in 41 patients, the infusion rate was reduced in 6 patients and infusion was discontinued due to intolerance in 10. CONCLUSIONS: Because needle catheter jejunostomy produces low morbidity and good tolerance to enteral nutrition, it is a valid alternative in patients with esophageal anastomosis.

Adult↗
PubMed1996

Roux-en-Y jejunostomy in the pediatric population.

Surgical access for nutrition is required in a variety of pediatric disorders. In some, the presence of gastroesophageal reflux, poor gastric emptying, and risks for fundoplication favor the use of a jejunostomy. The significant problems associated with the simple loop jejunostomy can be avoided by using the Roux-en-Y configuration. The stoma can be fashioned either Brook-style (intubatable) or Stamm-style (modified Maydl, permanently intubated). Both types are used at the authors' institution and are compared in this retrospective review. During a 27-month period, 22 Roux-en-Y jejunostomies were performed; nine of them had the Brook-style stoma and 13 had the modified Maydl stoma. Significant complications requiring reoperation occurred in three (33%) patients with a Brook-style jejunostomy: prolapse, leakage, and perforation of the stoma. None of the patients with modified Maydl jejunostomies required reoperation; problems were encountered more with the care of the permanently intubated stoma. Therefore, our preferred choice for a feeding jejunostomy is the modified Maydl approach.

Adolescent↗
PubMed2005

Laparoscopic feeding jejunostomy technique as part of staging laparoscopy.

Placement of a feeding jejunostomy tube is indicated for patients who need enteral access but where a gastrostomy is not feasible. This paper presents the technique and results of laparoscopic placement of feeding jejunostomy tubes in patients presenting with esophagogastric cancer. From December 2002 to February 2004, patients diagnosed with esophagogastric cancer with a potentially resectable lesion underwent staging laparoscopy. Laparoscopic feeding jejunostomy was performed on patients who were potential candidates for chemotherapy with palliative intent or neoadjuvant treatment prior to resection surgery. Surgical technique, recovery of bowel function, commencement of feeding jejunostomy, total time tube was in situ, and perioperative complications were analyzed. Of the 22 patients who underwent staging laparoscopy, a feeding jejunostomy tube was placed in 18. The remaining 4 patients were deemed to have advanced disease precluding any therapeutic options and underwent placement of esophageal stents. Feeding tubes remained in situ for a median time period of 76 days. Fourteen patients required enteral support and tubes were used for a median of 30 days. Complications from tube placement included 2 cases of wound infections, 1 of minor leak and 1 tube dislodgment. Patients were followed up for a median time of 112 days. Findings from current series suggest that placement of a feeding jejunostomy tube at the time of staging laparoscopy is a safe and reliable means of providing and maintaining nutrition for patients presenting with esophagogastric cancers.

Aged↗
PubMed2000

Can percutaneous endoscopic jejunostomy prevent gastroesophageal reflux in patients with preexisting esophagitis?

OBJECTIVE: Percutaneous endoscopic jejunostomy has been used for preventing pulmonary aspiration arising from gastric contents by concomitant jejunal feeding and gastric decompression in susceptible patients. Our objective was to evaluate gastroesophageal reflux in patients with percutaneous endoscopic jejunostomy tube feeding. METHODS: Eight cerebrovascular accident patients with percutaneous endoscopic jejunostomy tube placement caused by reflux esophagitis with hematemesis, food regurgitation or vomiting, and/or recurrent aspiration pneumonia were tested for gastroesophageal reflux using 24-h esophageal pH monitoring during continuous jejunal liquid meal or saline infusion with concomitant gastric decompression. Twenty-four hour pH monitoring was also performed during intragastric feeding on a different day. RESULTS: During the liquid meal feeding period, percutaneous endoscopic jejunostomy feeding reduced esophageal acid exposure 46% [12.9% (4.9-28.2%) versus 24.0% (19.0-40.6%), p = 0.01], compared to intragastric feeding. However, in the period of the jejunal tube infusion, esophageal acid exposure was significantly lower during saline infusion than during meal infusion [3.2 (0.0%-10.8%) versus 12.9% (4.9-28.2%), p = 0.008]. CONCLUSION: Percutaneous endoscopic jejunostomy feeding reduced but did not eliminate gastroesophageal reflux, compared to intragastric feeding in patients with severe gastroesophageal reflux. However, gastroesophageal reflux during percutaneous jejunal feeding was associated with meal infusion. This might, in part, explain the failure of percutaneous endoscopic jejunostomy tube placement to prevent pulmonary aspiration.

Aged↗
PubMed2004

Feeding jejunostomy: is there enough evidence to justify its routine use?

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.

Adult↗
PubMedDate not supplied

Comparison between open hand-sewn, laparoscopic stapled and laparoscopic computer-mediated, circular stapled gastro-jejunostomies in Roux-en-Y gastric bypass in the porcine model.

BACKGROUND: In this porcine survival model, we compared laparoscopic computer-mediated flexible circular stapled (SurgASSIST) gastro-jejunostomies in Roux-en-Y gastric bypass (RYGBP) to open hand-sewn (HS) and laparoscopic end-to-end (EEA) anastomosis. METHODS: RYGBP was performed in 15 pigs. Depending on the technique used to create the gastro-jejunostomy, the pigs were divided in 3 groups. In group A, a standard two-layer hand-sewn anastomosis were performed. In group B and C, gastro-jejunostomies using EEA (B) or SurgASSIST (C) were attempted. Operation time, intraoperative technical failure, postoperative anastomotic leakage, and necropsy results were measured. RESULTS: 14 pigs survived surgery. One leakage from the gastro-jejunostomy was detected intraoperatively in group B. There was no evidence of leakage postoperatively from the proximal gastro-jejunostomy in any groups. No statistical difference was found between the groups concerning the operation time or the diameter and degree of healing of the anastomosis. CONCLUSION: We found the SurgASSIST system safe for performing gastro-jejunostomies in laparoscopic RYGBP. There were no anastomotic failures intra- or postoperatively. At necropsy, there was no evidence of anastomotic stricture or delayed healing processes.

Anastomosis, Surgical↗
PubMed1999

Efficacy of jejunogram after jejunostomy insertion.

The era of managed care has spawned a national debate over the allocation of health care resources. We hypothesized that routine postjejunostomy jejunogram rarely provides additional clinical information or changes patient management and, therefore, is unwarranted. We retrospectively reviewed the charts of 128 consecutive patients undergoing feeding jejunostomy tube insertion between January 1995 and December 1996. All patients had postinsertion jejunograms. Eighty-five (66%) of the jejunograms were performed after operative insertion of the jejunostomy, and 43 (33%) were performed after percutaneous reinsertion of a previously placed jejunostomy. Data extracted from the charts include age, sex, indication for jejunogram, length of time prior jejunostomy was in place at time of reinsertion, and results of jejunogram. There were no patients (0%) with misplaced jejunostomy or extravasation of dye, as noted on jejunogram. There were no management changes implemented as a result of jejunogram readings (P < <0.05). The use of routine jejunogram after operative insertion or reinsertion of a prior jejunostomy that has become dislodged or occluded does not alter patient management, incurs unnecessary costs, and, therefore, is unwarranted.

Adolescent↗
PubMed1997

Laparoscopic jejunostomy with an 18-mm trocar.

We describe our technique to perform laparoscopic jejunostomies with an 18-mm trocar. This procedure facilitates the exteriorization of the proximal bowel and construction of the jejunostomy. We describe our laparoscopic technique in nine patients with severe neurologic conditions (two in the postoperative period of a cerebral aneurysm in a coma, three patients with severe head injury, and four patients with cerebrovascular strokes). The operative time ranged from 20 to 75 min (average, 44.38 min). Nutrition was initiated 24 h after the placement of the jejunostomy. Tolerance of the enteral nutrition was excellent in all cases. One major complication occurred, minor leakage around the feeding tube 3 weeks after the jejunostomy was constructed. The jejunostomy was removed without further consequences. Laparoscopy is an effective technique for the creation of feeding jejunostomies. We believe that this minimally invasive approach is an alternative for patients requiring long-term postpyloric enteral feeding.

Adult↗
PubMedDate not supplied

End to side mucomucosal Wirsung jejunostomy after pancreaticoduodenectomy: immediate results and long term follow-up.

BACKGROUND/AIMS: Pancreatico-duodenectomy (PD) is nowadays a widely performed operation which still carries a risk of some morbidity and mortality due to leakage of the Pancreatico-jejunostomy. The aim of the present paper is to describe critically the experience of a surgical team with a large number of consecutive non-selective PDs, where the same surgical procedure was adopted in all cases to manage the pancreatic stump. METHODOLOGY: Sixty six Whipple/Child PDs and 4 Traverso-Longmire (Duodenum Preserving PD) were performed between 1974 and 1993, by the same surgical team in our surgical department. The management of the pancreatic stump was always the same: a hand-made end-to-side mucomucosal Wirsung-jejunostomy, completed by a second layer between pancreatic capsula and jejunal sero-muscular wall. RESULTS: The overall mortality was 7.1% (5 cases). Only one death could be ascribed to pancreatico-jejunostomy related complications (post-operative acute pancreatitis). Specific morbidity was 12.6% (9 cases). Only one complication was related to the Wirsung-jejunostomy (leakage of the anastomosis, treated by a "sleeve" end-to-end pancreato-jejunostomy). Long-term patency of the anastomosis was shown by ERCP. CONCLUSIONS: Even if this anastomotic technique requires a little more time and attention by the surgeon, we think that the low incidence of pancreatico-jejunal anastomosis related complications represents a validation of the method, and a motivation to adopt this anastomotic technique. The long-term patency of the muco-mucosal Wirsung-jejunostomy is another valid argument that supports this kind of management of the pancreatic stump after PD.

Adult↗
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↗
PubMed2006

Proximal loop jejunostomy is a useful adjunct in the management of multiple intestinal suture lines in the septic abdomen.

BACKGROUND: Bowel repair in the septic abdomen can be problematic. This study investigated the use of a proximal loop jejunostomy to protect injured or fistulated bowel that had been returned to the abdomen after repair and/or anastomosis. METHODS: Ten patients who underwent laparotomy for intra-abdominal sepsis and/or fistulation, followed by distal enteric repair and/or anastomosis and construction of a proximal defunctioning loop jejunostomy, were studied retrospectively. Seven patients had 21 intestinal suture lines returned to the peritoneal cavity in the presence of intra-abdominal sepsis (14 anastomoses, two enterotomy closures and five serotomy repairs). Two patients had a difficult relaparotomy for pelvic abscess (two distal anastomoses, one enterotomy closure and three serotomy repairs). The final patient had pelvic sepsis and radiation enteritis; the distal anastomosis was defunctioned by a loop jejunostomy. RESULTS: The median distance from the duodenojejunal flexure to the loop stoma was 80 (range 30-170) cm. All jejunostomies were closed via a local approach, a median of 11 (range 9-18) months after formation. There was no significant postoperative morbidity and no postoperative death. At a median follow-up of 7 (range 0.5-56) months eight patients had no requirement for nutritional support. CONCLUSION: Use of a loop jejunostomy to protect suture lines in the septic abdomen justifies consideration of this procedure in selected patients.

Abdomen↗
PubMed2005

Laparoscopic feeding jejunostomy: a systematic review.

BACKGROUND: Enteral feeding devices have gained popularity since the beneficial effects of enteral nutrition have been clarified. Laparoscopic placement of a feeding jejunostomy is the most recently described enteric access route. In order to classify current surgical techniques and assess evidence on safety of laparoscopic feeding jejunostomy, a systematic review was performed. METHODS: The electronic databases Medline, Cochrane, and Embase were searched. Reference lists were checked and requests for additional or unpublished data were sent to authors. Outcome measures were surgical technique and catheter-related complications. RESULTS: Enteral access for feeding purposes can be effectively achieved by laparoscopic jejunostomy. Laparoscopic jejunostomy can be accomplished by either total laparoscopic or laparoscopic-aided techniques. The most experience was obtained with total laparoscopic placement. Which technique to apply should depend on the surgeon's expertise. Conversion rate is similar to other laparoscopic procedures. Complications can be serious and therefore strict patient selection should be warranted. CONCLUSION: Laparoscopic feeding jejunostomy is a viable method to obtain enteral access with the advantages of minimally invasive surgery.

Humans↗
PubMed2004

Laparoscopic needle catheter jejunostomy: modification of the technique and outcome results.

BACKGROUND: We describe a modification of the technique for laparoscopic jejunostomy in patients with stenosis of the upper gastrointestinal tract and assess the patients outcomes with this enteral access. METHODS: In a retrospective study of 80 patients, we evaluated the outcome of a modified technique for the laparoscopic placement of a jejunostomy catheter into the proximal jejunum. Standard laparoscopy equipment and ready-to-use jejunostomy catheters were used. After the creation of a pneumoperitoneum, the proximal jejunal loop was fixed to the parietal peritoneum. The jejunum was then punctured with a split needle, and the catheter (9F) was pushed into the jejunum. Finally, the catheter was secured with an additional purse-string suture. The external fixation was performed with nonabsorbable sutures. Enteral nutritional support with a polymeric enteral diet was initiated after fluoroscopic control on the first postoperative day at a rate of 20 ml/h. The flow rate was increased progressively until the nutritional goal of 60-80 ml/h was reached on the 3rd or 4th postoperative day. RESULTS: In all patients (n = 80), the placement site of the catheter was correct, and all patients were able to receive enteral nutrition on the 1st postoperative day. There were no intraoperative complications. The mean operating time was 51 min. Two patients developed a localized infection at the catheter site; one patient developed an abscess; and three patients had catheter obstructions. CONCLUSIONS: Patients in need of intermediate or long-term enteral nutrition may benefit from laparoscopic catheter jejunostomy. The technique described is safe, effective, and less invasive than alternative techniques of laparoscopic jejunostomy.

Aged↗
PubMed1996

Laparoscopic percutaneous jejunostomy for long term enteral access.

BACKGROUND: Patients suffering from upper gastrointestinal pathology may require jejunal feeding for adequate nutrition. A laparoscopically guided percutaneous jejunostomy offers a minimally invasive means of obtaining such feeding access. METHODS: Laparoscopic jejunostomy was performed in 32 patients. The most common indications were gastroparesis (n = 16), neurological deficits (n = 7), and proximal obstruction (n = 5). The proximal jejunum was affixed to the abdominal wall using intracorporeal and extracorporeal transabdominal sutures, allowing safe insertion of an 18-Fr Silastic dual-lumen tube. RESULTS: Laparoscopic jejunostomy was successfully completed for 28 patients; the procedure was converted to an open operation in four cases. Three of these four were among 14 patients undergoing the procedure who had a history of previous abdominal surgery. Major complications were observed in seven patients, including one reoperation and one death from aspiration pneumonia. Tube feeding was accomplished in all patients; progression to full enteral feeding proceeded without interruption in 20 patients. CONCLUSION: Laparoscopic jejunostomy can be performed with relative safety. Morbidity, though high, is usually related to preexisting disease. Previous abdominal surgery is not necessarily a contraindication to laparoscopic jejunostomy.

Enteral Nutrition↗