Jejunostomy tube placement throughout esophagectomy permits for earlier enteral feeding.
The need for a feeding surgical process ought to be individualized reckoning the amount of pre-operative obstruction and weight loss.
If the robotic platform is employed to perform the abdominal portion of the esophagectomy, it can even be utilized to perform the jejunostomy with virtual assistance.
The needle is then introduced into the abdomen underneath vision and conjointly the wire is placed into the peritoneal cavity. The track then gets serially expanded and, therefore the jejuna feeding tube is worked into the bodily cavity through the peel-away sheath present.
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Method
An antrostomy is performed within the small intestine (jejunum) using the forceps and therefore the feeding tube is placed inside the bowel's lumen. A purse string with 3–0 silk suture is then placed around the tube using robotic assistance.
Several studies have shown that jejunostomy feeding during the early postoperative period is safe and doesn't negatively impact survival in musculature (esophageal) cancer and robotic assistance makes it an easier process and saves a lot of labor.
This can help the surgeons to look after other things for the patient.
Álvarez-Sarrado et al. for instance showed that 82.9% of patients with feeding jejunostomy reached nutritional requirements postoperatively. Additionally, the utilization of postoperative FJ is usually short-lived and more than 77% of patients don't use their tube 30 days after surgery.
Therefore, FJ is taken into account as a valuable bridge for nutrition and should be considered in any patient who cannot maintain adequate oral intake within the perioperative period.
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LONG TUBES INSERTION
Long tubes are tubes inserted through the abdominal wall of the patient.
The end of the tube that stays inside the stomach or intestine features a mushroom-shaped end or internal balloon to keep the tube in the proper position.
An external bumper/ disc keeps the tube in position on the outside surface of the skin.
A longer part of the tube stays outside the body. The long end of the tube has one or more openings called ports.
The ports are used for feeding, giving medicines, or removing air or fluid from the stomach/intestine.
BUTTON TUBES
Button tubes are short feeding tubes that stay near to skin. A small balloon holds the end of the tube in position, inside the stomach/intestine. A port outside the skin attaches to a removable extension set for feedings.
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THE RISKS AND THE BENEFITS OF THE SURGERY IF DONE EARLY
There are inherent risks and controversies related to the placement of a jejunostomy feeding tube in patients with esophageal cancer regardless of timing.
Some complications associated with jejunostomy placement include bronchopneumonia, tube dislodgement leading to pneumoperitoneum and peritonitis, bowel obstruction, and abdominal wall infections.
A rare but often fatal complication associated with early jejunostomy feeding is an entity called non-occlusive mesenteric ischemia.
Given the various rates of complications that may occur with the placement of feeding jejunostomy tubes in patients with esophageal cancer, many authors have advocated for early oral intake after esophagectomy.
Enhanced Recovery After Surgery (ERAS) program in patients undergoing both minimally invasive and McKeown esophagectomy involved re-institution of a transparent liquid diet by postoperative day (POD)#3 and advancement to soft diet by POD#4.
The ERAS group was found to have a lower total complication rate compared to the non-ERAS group (27% vs. 44%), with earlier extubation and decreased ICU and hospital length of stay.
Conclusion
In conclusion, malnutrition is frequent in patients with esophageal cancer.
Placement of a feeding jejunostomy tube is to be performed in an exceedingly, minimally invasive fashion.
In view of a considerable complication rate, the selection to place a feeding tube should be individualized, and consideration made to the patients’ perioperative nutritional status and their ability to tolerate an oral intake.
References
Bakhos, Charles et al. “Jejunostomy-technique and controversies.” Journal of visualized surgery vol. 5 (2019): 33. DOI:10.21037/jovs.2019.03.15
Placement of G Tube, J Tube, and GJ Tube, Together, St. Jude Children's Research Hospital [Link]
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