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A simple, novel laparoscopic feeding jejunostomy technique to prevent bowel obstruction after esophagectomy: the “curtain method”

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Abstract

Background

Feeding jejunostomy (FJ) is a common treatment to support patients with esophageal cancer after esophagectomy. However, severe FJ-related complications, such as bowel obstruction, occasionally occur. We investigated the ability of our simple, novel FJ technique, the “curtain method,” to prevent bowel obstruction.

Methods

In laparoscopic surgery, the main mechanism of bowel obstruction involves torsion of the mesentery accompanied by migration of the intestine across the fixed FJ through the space surrounded by a triangle comprising the ligament of Treitz, fixed FJ, and spleen rather than adhesion. Our “curtain method” involves closure of this triangle zone with omentum, and the appearance of the lifted omentum resembles a curtain. Sixty patients treated with this modified FJ were retrospectively compared with 13 patients treated with conventional FJ in terms of the incidence of bowel obstruction, peritonitis, stoma site infection, and catheter obstruction.

Results

From 2013 to 2017, 60 patients underwent esophagectomy and gastric conduit reconstruction accompanied by modified laparoscopic FJ. The median observation period, including the period after tube removal, was 644 days. No FJ-associated bowel obstruction, the prevention of which was the primary aim, occurred in any patient. Likewise, no peritonitis or dislodgement occurred. Eight patients (13%) developed a stoma site infection with granulation. The feeding tube became occluded in 11 patients (18%); however, a new feeding tube was reinserted under fluoroscopy for all of these patients. From 2003 to 2012, 13 patients underwent conventional FJ. The median observation period was 387 days. Three patients (23%) developed bowel obstruction by torsion 71 to 134 days after the first surgery, and all were treated by emergency operations. Other FJ-related complications were not different from those in the modified FJ group.

Conclusion

Our simple, novel technique, the “curtain method,” for prevention of laparoscopic FJ-associated bowel obstruction after esophagectomy is a safe additional surgery.

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Acknowledgement

We thank Angela Morben, DVM, ELS, from Edanz Group, for editing a draft of this manuscript.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan

    Osamu Shiraishi, Hiroaki Kato, Mitsuru Iwama, Yoko Hiraki, Atsushi Yasuda, Ying-Feng Peng, Masayuki Shinkai, Yutaka Kimura, Motohiro Imano & Takushi Yasuda

Authors
  1. Osamu Shiraishi
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  2. Hiroaki Kato
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  3. Mitsuru Iwama
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  4. Yoko Hiraki
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  5. Atsushi Yasuda
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  6. Ying-Feng Peng
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  7. Masayuki Shinkai
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  8. Yutaka Kimura
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  9. Motohiro Imano
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  10. Takushi Yasuda
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Contributions

SO contributed to the study conception, data acquisition, data interpretation, and writing of the manuscript. YFP contributed to the data acquisition and writing of the manuscript. KH, IM, HY, YA, SM, KY, and IM contributed to the data acquisition. YT contributed to critical revision of the manuscript for important intellectual content. All authors approved the final version of the submitted manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Osamu Shiraishi.

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Disclosures

Osamu Shiraishi, Hiroaki Kato, Mitsuru Iwama, Yoko Hiraki, Atsushi Yasuda, Ying-Feng Peng, Masayuki Shinkai, Yutaka Kimura, Motohiro Imano, and Takushi Yasuda have no conflicts of interest or financial ties to disclose.

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Shiraishi, O., Kato, H., Iwama, M. et al. A simple, novel laparoscopic feeding jejunostomy technique to prevent bowel obstruction after esophagectomy: the “curtain method”. Surg Endosc 34, 4967–4974 (2020). https://doi.org/10.1007/s00464-019-07289-6

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  • DOI: https://doi.org/10.1007/s00464-019-07289-6

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