A simplified technique for laparoscopic jejunostomy and gastrostomy tube placement.
BACKGROUND
Percutaneous endoscopic gastrostomy and jejunostomy tube placement have long been considered the standard for supplying enteral nutrition when oral intake is not possible. Both have well-documented roles and limitations and are associated with a higher than generally appreciated incidence of aspiration. A distally placed tube in the jejunum decreases the chance of this morbid complication. Additionally, when percutaneous endoscopic gastrostomy is indicated but cannot be done for technical reasons, a minimally invasive alternative is desirable.


METHODS
In prior series, the techniques suggested for laparoscopic enteral access have characteristics that are either difficult for the average surgeon to duplicate, or use nonstandard anchoring techniques of the bowel to the abdominal wall. A simple, laparoscopically directed, percutaneous technique utilizing cost-effective appliances is described, and suggested indications are outlined.


RESULTS
This technique has been successfully applied in 46 patients with minimal complications.


CONCLUSIONS
A simplified technique for laparoscopic jejunostomy and gastrostomy tube placement is described. This has been successfully deployed in 46 patients with minimal morbidity. The procedure lessens the need for sophisticated suturing skills and duplicates standard small bowel to abdominal wall fixation methods.
Department of Surgery, Yale Endo-Laparoscopic Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
J C
JC
Rosser
E B
EB
Rodas
J
J
Blancaflor
R L
RL
Prosst
L E
LE
Rosser
R R
RR
Salem
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D004750:Enteral Nutrition / Q000295:instrumentation*; D004938:Esophageal Neoplasms / Q000628:therapy; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation*; D006258:Head and Neck Neoplasms / Q000628:therapy; D006801:Humans; D007582:Jejunostomy / Q000295:instrumentation*; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010166:Palliative Care; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D013274:Stomach Neoplasms / Q000628:therapy