Skip to main content

Advertisement

SpringerLink
Log in

The Optimal Feeding Enterostomy Creation During Esophagectomy to Reduce the Long-Term Risk of Small Bowel Obstruction

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Although feeding jejunostomy (FJ) is commonly created during esophagectomy for postoperative enteral nutrition, it can be a cause of postoperative small bowel obstruction (SBO). We introduced a technique of feeding enterostomy using the round ligament of the liver (FERL) to reduce SBO. In this study, we aimed to clarify the efficacy of FERL in reducing the postoperative SBO compared with FJ.

Methods

We assessed 400 consecutive patients who underwent esophagectomy with gastric tube reconstruction between 2011 and 2016, before and after the introduction of FERL (FJ, n = 200; FERL, n = 200). The cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy were compared between the FJ and the FERL groups.

Results

Thoracoscopic and laparoscopic surgery was more frequent in the FERL group than in the FJ group (p < 0.001). The cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy in the FERL group were significantly less frequent than those in the FJ group (p < 0.001 and p = 0.006, respectively). When stratifying by the abdominal surgical approach, the cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy in a laparoscopic approach were less frequent in the FERL group than those in the FJ group (both p < 0.001).

Conclusions

The FERL technique can reduce the incidences of postoperative SBO and SBO associated with feeding enterostomy in patients undergoing esophagectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Takeuchi H, Ikeuchi S, Kawaguchi Y et al (2007) Clinical significance of perioperative immunonutrition for patients with esophageal cancer. World J Surg 31:2160–2167. https://doi.org/10.1007/s00268-007-9219-8

    Article  PubMed  Google Scholar 

  2. Gupta V (2009) Benefits versus risks: a prospective audit. Feeding jejunostomy during esophagectomy. World J Surg 33:1432–1438. https://doi.org/10.1007/s00268-009-0019-1

    Article  PubMed  Google Scholar 

  3. Seike J, Tangoku A, Yuasa Y et al (2011) The effect of nutritional support on the immune function in the acute postoperative period after esophageal cancer surgery: total parenteral nutrition versus enteral nutrition. J Med Invest 58:75–80

    Article  Google Scholar 

  4. Choi AH, O’Leary MP, Merchant SJ et al (2017) Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer. J Gastrointest Surg 21:259–265

    Article  Google Scholar 

  5. Kawai R, Abe T, Uemura N et al (2017) Feeding catheter gastrostomy with the round ligament of the liver prevents mechanical bowel obstruction after esophagectomy. Dis Esophagus 30:1–8

    Article  CAS  Google Scholar 

  6. Park SY, Kim DJ, Byun GE (2019) Incidence and risk factors of readmission after esophagectomy for esophageal cancer. J Thorac Dis 11:4700–4707

    Article  Google Scholar 

  7. Koterazawa Y, Oshikiri T, Hasegawa H et al (2020) Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition. Dis Esophagus 33:doz021

    Article  Google Scholar 

  8. Watanabe M, Etoh K, Nagai Y et al (2011) Feeding tube insertion through the round ligament of liver: a safe approach to placing a feeding tube for retrosternal gastric tube reconstruction after esophagectomy. J Am Coll Surg 213:e21–e22

    Article  Google Scholar 

  9. Brierley JD, Wittekind GM, Union for International Cancer Control (2017) In: TNM classification of malignant tumors. Wiley, New Jersey

    Google Scholar 

  10. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  11. Baiu I, Hawn MT (2018) Small bowel obstruction. JAMA 319:2146

    Article  Google Scholar 

  12. Maung AA, Johnson DC, Piper GL et al (2012) Evaluation and management of small-bowel obstruction: an eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg 73:S362–S369

    Article  Google Scholar 

  13. Azagury D, Liu RC, Morgan A et al (2015) Small bowel obstruction: a practical step-by-step evidence-based approach to evaluation, decision making, and management. J Trauma Acute Care Surg 79:661–668

    Article  Google Scholar 

  14. Long B, Robertson J, Koyfman A (2019) Emergency medicine evaluation and management of small bowel obstruction: evidence-based recommendations. J Emerg Med 56:166–176

    Article  Google Scholar 

  15. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl 48:452–458

    Article  CAS  Google Scholar 

  16. Gabor S, Renner H, Matzi V et al (2005) Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction. Br J Nutr 93:509–513

    Article  CAS  Google Scholar 

  17. Blom RL, van Heijl M, Bemelman WA et al (2013) Initial experiences of an enhanced recovery protocol in esophageal surgery. World J Surg 37:2372–2378. https://doi.org/10.1007/s00268-013-2135-1

    Article  PubMed  Google Scholar 

  18. Heslin MJ, Latkany L, Leung D et al (1997) A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg 226:567–577

    Article  CAS  Google Scholar 

  19. Okamura A, Takeuchi H, Matsuda S et al (2015) Factors affecting cytokine change after esophagectomy for esophageal cancer. Ann Surg Oncol 22:3130–3135

    Article  Google Scholar 

  20. Takesue T, Takeuchi H, Ogura M et al (2015) A prospective randomized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal cancer. Ann Surg Oncol 22:S802–809

    Article  Google Scholar 

  21. Han-Geurts IJM, Hop WC, Verhoef C et al (2007) Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy. Br J Surg 94:31–35

    Article  CAS  Google Scholar 

  22. Elshaer M, Gravante G, White J et al (2016) Routes of early enteral nutrition following oesophagectomy. Ann R Coll Surg Engl 98:461–467

    Article  CAS  Google Scholar 

  23. Torres Júnior LG, de Vasconcellos Santos FA, Correia MITD (2014) Randomized clinical trial: nasoenteric tube or jejunostomy as a route for nutrition after major upper gastrointestinal operations. World J Surg 38:2241–2246. https://doi.org/10.1007/s00268-014-2589-9

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

Grant support: There is no grant support for this research.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Reiko Otake, Akihiko Okamura, Jun Kanamori, Keita Takahashi, Yuta Ushida, Yu Imamura, Shinji Mine & Masayuki Watanabe

Authors
  1. Reiko Otake
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihiko Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Kanamori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keita Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuta Ushida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yu Imamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shinji Mine
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masayuki Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akihiko Okamura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Human and animal rights

The study protocol was approved by the institutional review board of Cancer Institute Hospital of Japanese Foundation for Cancer Research (No. 2019-1227).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Otake, R., Okamura, A., Kanamori, J. et al. The Optimal Feeding Enterostomy Creation During Esophagectomy to Reduce the Long-Term Risk of Small Bowel Obstruction. World J Surg 44, 3845–3851 (2020). https://doi.org/10.1007/s00268-020-05701-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05701-0

Search

Navigation