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Feeding jejunostomy

Key principles

  • Allows enteral nutrition in patients who are unable to take sufficient food by mouth
  • Place high
  • Jejunum 10-20cm beyond DJ flexure
  • Afix to wall to shut off enterostomy from peritoneal cavity

I use an open technique to place a 9Fr feeding tube into the jejunum20-40cm from ligament of Treitz secured with a modified Witzel approach to the abdominal wall.

Operation Details

  • GA
  • Midline or left paramedian incision
    • Incision must be long enough to identify proximal jejunum and secure it to the abdominal wall
  • Select jejunum 20-40cm from DJ flexure
  • Ensure can pass loop to abdominal wall
  • Purse string suture
  • Enterotomy
  • Placement of feeding tube
  • Secure with purse string
  • Two options now:
    • Secure to the anterior abdominal wall with 4 quadrant sutures + distal and proximal anterior abdominal wall sutures to prevent twisting
    • Witzel
      • Lay the tube along the serosal surface of the jejunum for 6–8 cm proximally
      • Create a seromuscular tunnel over the tube using interrupted Lembert sutures leaving untied with needles on
      • The tube should be snugly covered by jejunal wall but not kinked or compressed
      • Bring the jejunal loop with the tube to the anterior abdominal wall without twisting
      • Use the same suture to secure to anterior abdominal wall at exit point, anchoring the bowel for 2cm

Complications

  1. Infection at the site
  2. Leakage of feeds at site
  3. Adhesions and small bowel obstruction
  4. Volvulus of the loop of small bowel around its fixation point
  5. Internal hernia
  • How to avoid complications
    • Some are avoidable, e.g. use broad-based fixation points rather than a single point around which the bowel can rotate
    • Tubes are smaller calibre than PEG tubes and are more likely to occlude if not flushed regularly
    • If occluded, they should not be removed but rather exchanged over a guide wire under radiological guidance
    • Blocked tubes may occur with some types of medications being put through the tube or if the tube is not flushed regularly enough. Most practitioners prefer that medications are not given via those tubes.

Graph View

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