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At least 163 records · Page 9Linked to original sources
PubMed2006

Laparoscopic latero-lateral jejuno-jejunostomy as a rescue procedure after complicated mini-gastric bypass.

Acute obstruction of jejunal limbs after gastric bypass surgery is rare but can result in a catastrophic scenario if the diagnosis is delayed. We report a 31-year-old female who developed acute efferent limb obstruction after a laparoscopic mini-gastric bypass (MGB), manifested as recurrent episodes of epigastric discomfort and bile-stained vomiting. The diagnosis was evident on oral contrast studies. She was successfully treated by a salvage laparoscopic side-to-side anastomosis between the efferent limb and the afferent limb 4 cm distal to the gastro-jejunostomy. Acute obstruction of the efferent limb after a MGB operation can be easily diagnosed and effectively treated by laparoscopic latero-lateral jejuno-jejunostomy.

Adult↗
PubMed2004

Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs.

OBJECTIVE: To evaluate feasibility of performing laparoscopic-assisted placement of a jejunostomy feeding tube (J-tube) and compare complications associated with placement, short-term feedings, and medium-term healing with surgically placed tubes in dogs. DESIGN: Prospective study. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly allocated to undergo open surgical or laparoscopic-assisted J-tube placement. Required nutrients were administered by a combination of enteric and oral feeding while monitoring for complications. Radiographic contrast studies documented tube direction and location, altered motility, or evidence of stricture. RESULTS: Jejunostomy tubes were successfully placed in the correct location and direction in all dogs. In the laparoscopic group, the ileum was initially selected in 2 dogs, 2 dogs developed moderate hemorrhage at a portal site, and 2 J-tubes kinked during placement but were successfully readjusted postoperatively. All dogs tolerated postoperative feedings. All dogs developed minor ostomy site inflammation, and 1 dog developed bile-induced dermatitis at the ostomy site. Despite mild, transient neutrophilia, no significant difference was noted in WBC counts between groups. No dog had altered gastric motility or evidence of stricture, although the jejunopexy site remained identifiable in several dogs at 30 days. CONCLUSIONS AND CLINICAL RELEVANCE: Requirements for successful J-tube placement were met by use of a laparoscopic-assisted technique, and postoperative complications were mild and comparable to those seen with surgical placement. Laparoscopic-assisted J-tube placement compares favorably to surgical placement in healthy dogs and should be considered as an option for dogs requiring enterostomy feeding but not requiring a celiotomy for other reasons.

Animals↗
PubMed2000

Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding.

OBJECTIVE: To assess the results of direct percutaneous endoscopic jejunostomy (DPEJ) as a method for jejunal feeding. PATIENTS AND METHODS: We conducted a retrospective study of all patients who were referred for DPEJ between October 1998, when the procedure was implemented at our institution, and January 2000. Medical records were reviewed to assess technical success, complications, and the need for repeat procedures. Patient satisfaction with DPEJ was also evaluated by means of standardized telephone interviews. RESULTS: In 26 (72%) of 36 patients, DPEJ placement was successful. During the mean follow-up of 107 days, none of the patients with DPEJ required reintervention for tube malfunction or displacement. Two patients developed a persistent enterocutaneous fistula following the removal of the DPEJ tube. No other procedure-related complications were noted. Fifteen (78%) of 19 patients who responded to follow-up questions reported an overall satisfaction rating of 8 or higher on a 10-point scale (1, completely dissatisfied, to 10, completely satisfied). CONCLUSIONS: We conclude that DPEJ is an effective and safe method for providing jejunal tube feeding. A low reintervention rate along with high patient satisfaction makes DPEJ an attractive alternative to the more commonly placed jejunostomy feeding tubes.

Adult↗
PubMedDate not supplied

[Laparoscopic jejunostomy in malnourished surgical patients: indications and technique].

Laparoscopic jejunostomy (LJ) represents a new way of enteral nutrition (EN) for surgical malnourished patients. LJ is an alternative form of therapy, with restricted indications to the few cases when classical way for EN (nosogastroenteral tube feeding, PEG/PEJ, surgical gastrostomy), are contraindicated or can not be used, and the patient is unable to eat. This technique is also preferred to the open surgical jejunostomy. The paper describes our LJ technique, indications and contraindications. We used JL in two surgical severely malnourished patients, within 11 and 14 days, before the elective, open, curative operations. In this period the patients where exclusively nourished with special feeding solutions through the LJ catheter. The main pathologic lesions were: extrinsec antral obstruction from a perforated transverse colon carcinoma in the omental pouch, in the first case, and proximal inflammatory stenosis of efferent loop, after gastric resection with Billroth II anastomosis for duodenal ulcer, in the second case. LJ gives the opportunity for the exploration of the whole abdominal cavity, and for the direct imaging of the pathological lesions. With EN being delivered before the open, elective operations, we get an amelioration of serum albumin values, and we have no morbidity related to the LJ or open, curative operation. EN was administrated after open surgery in the same way, and in the first case, during chemotherapy. LJ is an efficient, miniinvasive way for EN, in selected surgical severe malnourished patients with proximal digestive obstructions, especially oncologic ones, the aim being an amelioration of the nutritional status and a reduction of postoperative morbidity. A continuous study on a larger number of cases is imperative necessary.

Contraindications↗
PubMed1991

Complications of jejunostomy tube feeding in nursing facility patients.

Maintaining nutrition in patients who are unable to eat is difficult. Jenunostomy feeding has been recommended, especially for patients known to aspirate, but few data are available regarding its efficacy in the nursing home setting. We performed a retrospective review of 44 consecutive jejunostomy fed patients in a skilled nursing facility (SNF) to determine the incidence of complications, particularly aspiration pneumonia. Among them, 81.8% experienced at least one complication, most frequently tube dislodgement or obstruction. In 52.2%, intervention by the physician was required before feeding could be resumed. The incidence of aspiration pneumonia was 15.9%: 31.6% in patients who had previously aspirated and 4% in those without previous aspiration (p less than 0.05). We conclude that jejunostomy feeding does not protect against aspiration pneumonia in patients known to aspirate, and that the high overall complication rate makes its use problematic in the SNF setting.

Aged↗
PubMed1990

Feeding jejunostomy: a safe adjunct to laparotomy.

It is well established that a feeding jejunostomy is an invaluable adjuvant for use in critically ill and malnourished patients. What is not well known are the complications of inserting these tubes. Some surgeons are reluctant to insert feeding tubes unless the indications are very clear. From their experience with the insertion of 133 feeding jejunostomy tubes during a 3-year period, the authors conclude that the complications associated with the insertion of such tubes are few and that the procedure is justified even if the tube is never used.

Enteral Nutrition↗
PubMed1990

[Manometric study of two Roux-en-Y hepatico-jejunostomy].

The aim of this study was to describe (during the fasting state in two patients the motor activity of the limb in Roux-en-Y hepatico-jejunostomy). In the two patients, the limb was created 15 years and 15 days prior to the study respectively. Recordings were performed with a low compliance pneumohydraulic system below the jejuno-jejunal anastomosis then in the limb. Motor studies in the limb were coupled with recordings carried out in the duodenum. In both patients, the regular occurrence of a typical phase III (PIII) activity was demonstrated in the limb whereas no retrograde or abnormal motor patterns were found. PIIIs in the limb were uncoordinated with duodenal PIIIs. Trimebutine, given intravenously, induced a typical PIII activity in the duodenum and the limb simultaneously. Spontaneous or trimebutine-induced PIIIs in the limb had a slower migration velocity (p less than 0.01) than duodenal PIIIs. Lastly, we were unable to record PIIIs in the distal jejunum below the jejuno-jejunal anastomosis despite the lack of associated abnormal motor patterns. This study demonstrates that a normally propagated PIII activity can be observed in the limb in Roux-en-Y hepatico-jejunostomy immediately or several years after the surgical procedure.

Anastomosis, Roux-en-Y↗
PubMed1989

Feeding jejunostomy in patients who are critically ill.

Nutritional support of critically or chronically ill patients is essential. Enteral feeding is preferred and can be accomplished with a feeding jejunostomy tube in selected patients. Complications relative to tube type have been identified herein. Selection of a cuffed tube jejunostomy using a Tenckhoff catheter, placed by the method presented herein, is recommended to minimize the occurrence of these complications and to facilitate nutritional therapy.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[Nutritional and defunctionalized jejunostomy in the chemotherapeutic treatment of gastric non-Hodgkin's lymphoma. Preliminary experience].

The authors propose a jejunostomy on an omega loop distal to the Treitz ligament as a treatment for unresectable gastric lymphomas. The rationale is to provide nutritional support during chemotherapy in a situation when the stomach is defunctionalised. As assessed by clinical, morphological and biological parameters, the association of chemotherapy and jejunostomy may represent a valid therapeutical strategy for patients considered unresectable.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Nutritional support by tube jejunostomy.

Access to the jejunum by orogastric intubation or insertion of a surgical tube provides a method for nutrient infusion in clinical conditions that involve abnormal upper gastrointestinal function. Despite the physiologically extraordinary nature of jejunostomy intubation-with enteral infusions beyond the stomach, biliary tract, pancreas, and duodenum--the current view is that jejunal feeding is an acceptable alternative to parenteral nutritional support. Because jejunostomies utilize the gastrointestinal tract, administering feedings by this route can minimize some of the major adverse effects of total intravenous nutrition. The problems with jejunal intubation relate to the technical difficulty of the procedure itself, indications for its general use, and its adaptation as an adjunct in the management of the surgical patient. The timing, composition, and metabolic effects of jejunal nutrient infusions are the subject of continuing debate and study.

Animals↗
PubMedDate not supplied

Evaluation of choledochojejunostomy with subcutaneous jejunostomy for treatment of intrahepatic stones.

Twenty-nine patients, 16 males and 13 females, with intrahepatic stones were treated by choledochojejunostomy with subcutaneous jejunostomy after choledocholithotomy in cases where the common bile duct was dilated more than 2 cm in diameter. This surgical technique consists of putting a segment of jejunum in the subcutaneous area with a jejunostomy after finishing the choledochojejunostomy. If the stone recurs years later, this loop of jejunum will offer a route for inserting the scope while producing the fistulotomy under local anesthesia. These patients became symptomless soon after removal of the residual stone by postoperative choledochoscope. After more than five years of follow-up study, seven cases (24.1%) had reflux cholangitis and among them, four patients had recurrent stones. Reopening of the fistulotomy was carried out under local anesthesia, and the choledochoscope was inserted into the bile duct through the jejunum for removal of those recurrent stones. We believe that this surgical technique is very effective for the treatment of patients with recurrent intrahepatic stones without the necessity of major laparotomy.

Adult↗
PubMed1994

A technique of direct percutaneous jejunostomy tube placement.

A technique for replacement of a feeding jejunostomy tube using endoscopic direct visualization is described herein. It can be used in patients who have had a previously placed open jejunostomy tube removed after recovery from resection of the gastrointestinal tract. This is accomplished quite easily using local anesthesia with intravenous sedation using an upper endoscope, guide wire, peel-away sheath and a standard Silastic catheter.

Enteral Nutrition↗
PubMed1996

Small bowel necrosis in association with jejunostomy tube feedings.

Nutritional support is thought to be an important adjunct for minimizing perioperative morbidity. For a variety of reasons, it is now felt that nutrition delivered by the enteral route is preferred over that given parenterally. Although delivery of nutrients into the small intestine, either via a nasoduodenal tube or a surgically placed jejunostomy, is effectively tolerated by most patients, morbid complications are being described with increased frequency. Herein, we describe two patients who underwent major intra-abdominal surgery, one for a malignancy, the other for trauma management. Immediate postoperative feedings were instituted through a surgically placed jejunostomy tube. Several days later, each patient underwent emergency reoperation for clinical findings of an intra-abdominal catastrophe. In both patients, small intestinal infarction in juxtaposition to the site of the tube feedings was found. This experience suggests that the enteral feedings were causally related to this morbid complication, which proved fatal in one patient.

Adult↗
PubMed1996

[Direct percutaneous endoscopic jejunostomy, variation of the technique of gastrostomy].

Percutaneous endoscopic gastrojejunostomy is a percutaneous endoscopic gastrostomy derived technique, that is widely employed. However it has a high incidence of mechanic complications. Percutaneous endoscopic jejunostomy direct access, improves these problems and allows to apply this technique in patients with previous gastric resection or with other gastric diseases that contraindicate percutaneous endoscopic gastrostomy. We describe, for the first time in our country, a direct percutaneous endoscopic jejunostomy placement.

Gastrostomy↗
PubMedDate not supplied

Technical complications of feeding jejunostomy: a critical analysis.

INTRODUCTION: A retrospective review of patients undergoing feeding jejunostomy (FJ) was undertaken in order to evaluate procedure related complications and their impact on final outcome. PATIENTS AND METHODS: Ninety six patients had FJ at the department of Surgical Gastroenterology, SGPGIMS from January 1989 to December 1995. RESULTS: FJ as an adjunct was performed in 89 patients with predominantly oesophageal (n = 62) and pancreatic surgery (n = 17). Seven patients had FJ as the only procedure. Fifteen patients (15.2%) had complications related to FJ. Minor complications (7.2%) included dislodgement (n = 3), blockage of the tube (n = 2) and pericatheter leak (n = 2). Major complications (8.3%) which needed surgical intervention were, detachment of the jejunostomy from the abdominal wall (n = 3), leak into the peritoneal cavity (n = 3), jejunal perforation by the tip of the catheter (n = 1) and peritonitis after removal of the tube (n = 1). Procedure related mortality was 3.2%. CONCLUSIONS: FJ should not be treated as a minor procedure and due attention to the technical details is required in its performance, otherwise it may well become the cause of a poor result following a very successful major operation.

Adolescent↗
PubMed1997

Surgical technique. Intracorporeal laparoscopic-guided feeding jejunostomy.

Laparoscopic feeding jejunostomy is a safe and reproducible method of establishing enteral feeding in patients in whom percutaneous endoscopic gastrostomy is contraindicated. Current technology enables the jejunostomy to be achieved within the peritoneal cavity, without retrieval of the small bowel through the abdominal wall. This quick and simple technique is described.

Contraindications↗
PubMed1998

[Laparoscopic fine needle catheter jejunostomy].

Gastrostomy or jejunostomy allow a safe and effective long-term enteral nutritional support. In patients with stenosis of the upper gastrointestinal tract the percutaneous endoscopic route is frequently not feasible. In these cases a laparoscopic approach is proposed. In 18 patients (n = 18) mostly with recurrent tumors of the upper gastrointestinal tract a laparoscopic catheter was placed into the jejunum without complications. Enteral feeding was started on the first day after catheter placement. One patient experienced a cathetersite infection. We describe a modified technique of laparoscopic jejunostomy the placement which is easy, effective and less invasive.

Catheters, Indwelling↗
PubMed1979

Maintenance of home hyperalimentation in patients with high-output jejunostomies.

We studied four patients with high-output end jejunostomies (greater than 3,000 mL/day) who were receiving home hyperalimentation. With knowledge of urine and stoma output, standard total parenteral nutrition fluid was infused and titrated according to individual needs, first during the hospital stay and then on follow-up office visits. Mean daily stoma output for the group was 3,556 mL/day. With oral fluid intake restricted to 1,500 mL/day, average daily stoma output dropped to 2,892 mL. The mean daily volume of nutrient fluid required to achieve stabel biochemistries and weight was 3,550 mL. Daily caloric requirements ranged from 23 kcal/kg to 44 kcal/kg, with a mean of 32.5 kcal/kg. Amino acid requirements averaged 1.6 g/kg. With 65 patient months of continuous overnight catheter infusion, there have been no serious metabolic derangements or deaths. The program of home hyperalimentation can maintain a satisfactory metabolic state in patients with high-output jejunostomies.

Amino Acids↗