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Primary placement technique of jejunostomy using the entristar™ skin-level gastrostomy tube in patients with esophageal cancer.

Rino Y, Yukawa N, Murakami H, Sato T, Takata K, Hayashi T, Oshima T, Wada N, Masuda M, Imada T - BMC Gastroenterol (2011)

Bottom Line: The SLJT was successfully inserted in all 16 patients.No early complications were documented.This SLJT placement technique using the G-tube is a safe procedure in patients with EC and allows the creation of a long-term feeding jejunostomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Yokohama City University, School of Medicine 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan. rino@med.yokohama-cu.ac.jp

ABSTRACT

Background: We developed a skin-level jejunostomy tube (SLJT) procedure for patients undergoing esophagectomy using a skin-level gastrostomy tube (G-tube) (Entristar™; Tyco Healthcare, Mansfield, Mass), in order to improve their nutrition status and quality of life (QOL). We describe the procedure and the adverse effects of SLJT in patients with esophageal cancer (EC).

Methods: Over a 24-month period (March 2008 to March 2010), there were 16 patients (mean age: 61.8 years; age range: 49-75 years; 15 men, 1 woman) who had Stage II or III EC. Primary jejunostomy was performed under general anesthesia during esophagectomy. The technical success and the immediate and delayed complications of the procedure were recorded. JEJUNOSTOMY TECHNIQUES: SLJT placement using the G-tube (20Fr) was performed 20 cm from the Treitz ligament on the side opposing the jejunal mesenterium. The internal retention bolster was exteriorized through an incision in the abdominal wall. A single purse string suture using a 4-0 absorbable suture was performed. The internal retention bolster was then inserted into the jejunal lumen via the small incision. The intestine adjacent to the tube was anchored to the peritoneum using a single stitch.

Results: The SLJT was successfully inserted in all 16 patients. No early complications were documented. Follow-up for a median of 107 days (range, 26-320 days) revealed leakage to the skin in four patients, including superficial wound infections in two patients. There were no cases of obstruction of the tube or procedure-related death.

Conclusions: This SLJT placement technique using the G-tube is a safe procedure in patients with EC and allows the creation of a long-term feeding jejunostomy.

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Related in: MedlinePlus

Jejunostomy technique 1. A) A purse string suture of the jejunostomy tube using a 4-0 absorbable suture. B) Insert the Stoma Measuring Device through the abdominal wall into the abdominal cavity. C) Measure the abdominal wall thickness. D) Use the finger grips on the GripStar Device for retention during obturation and insertion. E) Insert the obturated G-Tube into the stoma tract until the internal retention portion can be seen perfectly in the abdominal cavity.
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Figure 2: Jejunostomy technique 1. A) A purse string suture of the jejunostomy tube using a 4-0 absorbable suture. B) Insert the Stoma Measuring Device through the abdominal wall into the abdominal cavity. C) Measure the abdominal wall thickness. D) Use the finger grips on the GripStar Device for retention during obturation and insertion. E) Insert the obturated G-Tube into the stoma tract until the internal retention portion can be seen perfectly in the abdominal cavity.

Mentions: During the procedure, the patient is placed in a supine position. We perform the jejunostomy during the abdominal procedure at the end of the esophageal cancer operation. We perform the jejunostomy 20 cm from the Treitz ligament on the side opposing the jejunal mesenterium. A single purse string jejunostomy stitch is made using a 4-0 absorbable suture (Figure 2.A). The stitch length is about 10 mm and four stitches are performed in a square shape around the jejunostomy site.


Primary placement technique of jejunostomy using the entristar™ skin-level gastrostomy tube in patients with esophageal cancer.

Rino Y, Yukawa N, Murakami H, Sato T, Takata K, Hayashi T, Oshima T, Wada N, Masuda M, Imada T - BMC Gastroenterol (2011)

Jejunostomy technique 1. A) A purse string suture of the jejunostomy tube using a 4-0 absorbable suture. B) Insert the Stoma Measuring Device through the abdominal wall into the abdominal cavity. C) Measure the abdominal wall thickness. D) Use the finger grips on the GripStar Device for retention during obturation and insertion. E) Insert the obturated G-Tube into the stoma tract until the internal retention portion can be seen perfectly in the abdominal cavity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040710&req=5

Figure 2: Jejunostomy technique 1. A) A purse string suture of the jejunostomy tube using a 4-0 absorbable suture. B) Insert the Stoma Measuring Device through the abdominal wall into the abdominal cavity. C) Measure the abdominal wall thickness. D) Use the finger grips on the GripStar Device for retention during obturation and insertion. E) Insert the obturated G-Tube into the stoma tract until the internal retention portion can be seen perfectly in the abdominal cavity.
Mentions: During the procedure, the patient is placed in a supine position. We perform the jejunostomy during the abdominal procedure at the end of the esophageal cancer operation. We perform the jejunostomy 20 cm from the Treitz ligament on the side opposing the jejunal mesenterium. A single purse string jejunostomy stitch is made using a 4-0 absorbable suture (Figure 2.A). The stitch length is about 10 mm and four stitches are performed in a square shape around the jejunostomy site.

Bottom Line: The SLJT was successfully inserted in all 16 patients.No early complications were documented.This SLJT placement technique using the G-tube is a safe procedure in patients with EC and allows the creation of a long-term feeding jejunostomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Yokohama City University, School of Medicine 3-9, Fukuura, Kanazawa-ku, Yokohama city, 236-0004, Japan. rino@med.yokohama-cu.ac.jp

ABSTRACT

Background: We developed a skin-level jejunostomy tube (SLJT) procedure for patients undergoing esophagectomy using a skin-level gastrostomy tube (G-tube) (Entristar™; Tyco Healthcare, Mansfield, Mass), in order to improve their nutrition status and quality of life (QOL). We describe the procedure and the adverse effects of SLJT in patients with esophageal cancer (EC).

Methods: Over a 24-month period (March 2008 to March 2010), there were 16 patients (mean age: 61.8 years; age range: 49-75 years; 15 men, 1 woman) who had Stage II or III EC. Primary jejunostomy was performed under general anesthesia during esophagectomy. The technical success and the immediate and delayed complications of the procedure were recorded. JEJUNOSTOMY TECHNIQUES: SLJT placement using the G-tube (20Fr) was performed 20 cm from the Treitz ligament on the side opposing the jejunal mesenterium. The internal retention bolster was exteriorized through an incision in the abdominal wall. A single purse string suture using a 4-0 absorbable suture was performed. The internal retention bolster was then inserted into the jejunal lumen via the small incision. The intestine adjacent to the tube was anchored to the peritoneum using a single stitch.

Results: The SLJT was successfully inserted in all 16 patients. No early complications were documented. Follow-up for a median of 107 days (range, 26-320 days) revealed leakage to the skin in four patients, including superficial wound infections in two patients. There were no cases of obstruction of the tube or procedure-related death.

Conclusions: This SLJT placement technique using the G-tube is a safe procedure in patients with EC and allows the creation of a long-term feeding jejunostomy.

Show MeSH
Related in: MedlinePlus