Prophylactic tube jejunostomy: a worthwhile undertaking.
OBJECTIVE
The status of tube jejunostomy for feeding after major gastrointestinal and pancreatobiliary surgery is being questioned because of concerns about procedure-related complications. This has led to a trend away from performing routine prophylactic tube jejunostomy.


METHODS
We retrospectively analyzed 120 consecutive patients who underwent prophylactic tube jejunostomy as part of major gastrointestinal or pancreatobiliary surgery within a 2-year period at a tertiary referral center. The primary end-points were procedure-related morbidity and mortality. We also performed a subset analysis of the duration of enteral feeds and the need for parenteral nutrition (PN) in patients with complications related to the index surgery.


RESULTS
There was no procedure-related mortality or major morbidity. Eight patients (6.7%) required supplementation with PN because enteral feeding failed to achieve the nutritional target. Patients who suffered complications required nutritional support for significantly longer (10.8 days vs 6.4 days; P < 0.001). The nutritional goal of 25 kcal/kg per day was attained with tube jejunostomy feeding in 82 (93%) of 84 patients without complications and in 30 (83%) of 36 patients with complications (P = 0.180).


CONCLUSIONS
Prophylactic tube jejunostomy is safe and can be performed with low procedure-related morbidity. When postoperative complications result in delayed or inadequate oral intake, nutritional requirements can be met through tube jejunostomy feeds.
Department of Surgical Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India.
Anand
A
Ramamurthy
Sanjay Singh
SS
Negi
Adarsh
A
Chaudhary
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007582:Jejunostomy; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies