Single-incision laparoscopic-assisted jejunostomy tube placement

Background: Feeding jejunostomy is an alternative enteral nutritional supplementation method for patients with functional gastrointestinal tracts. In this study, we introduced the novel, safe technique of single-incision laparoscopic-assisted jejunostomy (SIL-AJ) tube placement. Subjects and Methods: We conducted a prospective record search and a retrospective review of all patients who received surgical jejunostomy tube placement in Chang Gung Memorial Hospital, Linkou, Taiwan, from October 2011 to December 2012. SIL-AJ, multiple-incision laparoscopic jejunostomy (MIL-J), and open jejunostomy (O-J) were performed concurrently. We compared the demographic data, operative time, postoperative pain control, and postoperative complications among these groups. Results: Forty patients who received surgical jejunostomy in this period were enrolled in the study. There were 14 patients with SIL-AJ, 10 with MIL-J, and 16 with O-J. There were no differences in age, sex, American Society of Anesthesiologists status, body mass index, or malignancy distribution among the SIL-AJ, MIL-J, and O-J groups. The total operative times for the SIL-AJ, MIL-J, and O-J procedures were 53.3±11.5, 117.3±45.8, and 52.9±16.1 minutes, respectively; SIL-AJ and O-J had similar operative times, which were significantly shorter than the operative times in the MIL-J group (P<.001). The proportions of patients who began feeding within 24 hours in the SIL-AJ, MIL-J, and O-J groups were 100%, 70%, and 37%, respectively; the SIL-AJ group had a higher feeding rate at 24 hours than the two other groups (P=.001). The SIL-AJ and MIL-J groups had fewer postoperative complications than the O-J group (P=.011). Conclusions: SIL-AJ is a feasible and safe procedure that can be performed in patients who require alternative enteral feeding. Reduced postoperative pain, acceptable incisions, and quick feeding were observed in patients with SIL-AJ. Transumbilical SIL-AJ uses cost-effective appliances, and it is a relatively simple technique to learn and in which togain proficiency.