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Laparoscopic vs. open feeding jejunostomy: a systemic review and meta-analysis

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Abstract

Background

Feeding jejunostomy is a solid way for patients to maintain enteral nutrition. However, debate over the superiority of the laparoscopic vs. laparotomic method has raised concerns in recent years. This systemic review and meta-analysis aimed to compare the postoperative outcomes between these two approaches.

Methods

We searched PubMed, Embase, and Scopus from the date of inception to April 2022 for studies comparing laparoscopic and open feeding jejunostomy. Study characteristics and outcomes were extracted from the included articles. The primary outcome was the relative risk (RR) of postoperative complications in each group. We also analyzed the major/minor complication rates and operations, excluding major concomitant procedures. The risk of bias of included studies were assessed using the ROBINS-I tool. The certainty of evidence was rated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

A total of seven retrospective studies with 1195 patients in total were included in this systemic review and meta-analysis. Laparoscopic feeding jejunostomy carried a significantly lower postoperative complication rate (RR: 0.62; 95% CI, 0.42–0.91, p = 0.02, low certainty of evidence) compared with laparotomy, and the heterogeneity was moderate (I2 = 34%, p = 0.18). After excluding major concomitant procedures, the RR between the laparoscopic and open group was 0.48 (95% CI, 0.33–0.70, p < 0.001, low certainty of evidence), suggesting that the laparoscopic approach was superior in terms of postoperative complications.

Conclusions

Our results indicate that laparoscopic feeding jejunostomy might reduce the postoperative overall complication rate compared with open feeding jejunostomy.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan

    Ted Hsiung, Wu-Po Chao, Shion Wei Chai, Ta‑Chun Chou, Chih-Yuan Wang & Ting-Shuo Huang

  2. Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, 259, Taiwan

    Ting-Shuo Huang

  3. Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 20401, Taiwan

    Ting-Shuo Huang

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Ted Hsiung, Wu-Po Chao, Shion Wei Chai, Ta‑Chun Chou, Chih-Yuan Wang, and Ting-Shuo Huang have no conflicts of interest or financial ties to disclose.

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Supplementary file1 (JPG 959 kb)—Supplementary Fig. 1 Sensitivity analysis using the leave-one-out method

464_2022_9782_MOESM2_ESM.jpg

Supplementary file2 (JPG 406 kb)—Supplementary Fig. 2 Overall postoperative complication rate between laparoscopic and open feeding jejunostomy excluding studies with critical confounding bias. The size of the squares is proportional to the weight of each study. The horizontal lines are the 95% confidence interval (CI) of each study. The diamond is the pooled effect with 95% CI. RR stands for relative risk

464_2022_9782_MOESM3_ESM.jpg

Supplementary file3 (JPG 354 kb)—Supplementary Fig. 3 Short-term complications (≤ 30 days of surgery). The size of the squares is proportional to weight of each study. The horizontal lines are the 95% confidence interval (CI) of each study. The diamond is the pooled effect with 95% CI. RR stands for relative risk

Supplementary file4 (DOCX 13 kb)

Supplementary file5 (DOCX 19 kb)

Supplementary file6 (DOCX 13 kb)

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Hsiung, T., Chao, WP., Chai, S.W. et al. Laparoscopic vs. open feeding jejunostomy: a systemic review and meta-analysis. Surg Endosc 37, 2485–2495 (2023). https://doi.org/10.1007/s00464-022-09782-x

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