[Needle catheter jejunostomy versus "Witzel" tube jejunostomy for early postoperative enteral nutrition in surgical patients. Prospective randomized study].
Malnutrition in surgical patients can be present since their admission into hospital or can appear in the postoperative period. Early postoperative enteral nutrition (EPEN) is recommended to these patients as often as possible. In cases where the patients are severely malnourished with major digestive surgical interventions which we estimate that will be unable to feed orally efficient minimum 7-10 days postoperatively, we recommend EPEN on jejunostomy. Prospective randomized evaluation of 37 patients (75.6% severely malnourished): 19 with needle catheter jejunostomy (NCJ), group A, respectively 18 with standard "Witzel" tube jejunostomy (STJ), group B. 22 patients presented malignant tumors and 15 serious benign problems. On 7 patients the jejunostomy was done at the reoperation. Postoperative major complications were observed on 54.05% of the patients (independent of the jejunostomy) and the postoperative mortality rate was of 13.33% on the patients that had jejunostomy and EPEN on their first operation, and 57.14 respectively on the patients where jejunostomy was done at the reoperation. The two groups were similar with respect to age, sex, length of EPEN and hospital stay, presence of malnutrition, complications and mortality. Postoperative complications were statistically more frequent in anemic patients (68.8%) respectively anemic and severely malnourished (76.47). Minor complication related to the jejunostomy occurred in 5.6% of the group A and 22.2% of the group B. NCJ was done rapidly the same as STJ (7 min vs. 15 min). In conclusion, EPEN on jejunostomy on surgically malnourished patients, who have suffered major superior digestive interventions is beneficial. Postoperative complications have been more frequent on anemic and severely malnourished. NCJ is easier to perform and safer.
Clinica de Chirurgie, Spitalul de Urgenţă Floreasca, Bucureşti. anicolau@easynet.ro
A E
AE
Nicolau
Irina
I
Grecu
V
V
Veste
V
V
Merlan
M
M
Beuran
Ioana
I
Grinţescu
D000293:Adolescent; D000328:Adult; D002404:Catheterization; D002648:Child; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D005767:Gastrointestinal Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D007582:Jejunostomy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D044342:Malnutrition / Q000517:prevention & control / Q000628:therapy; D008875:Middle Aged; D009339:Needles; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D012383:Romania; D015996:Survival Rate