title: The "omega" jejunostomy tube: A preferred alternative for postpyloric feeding access.
abstract: OBJECTIVE
  We present our technique for construction of the "Omega Jejunostomy" (OJ), a novel method of postpyloric feeding using a pouched-jejunal loop capable of accommodating a balloon gastrostomy button. We describe potential indications for the procedure and outcomes in a complex patient population.
  
  
  METHODS
  We retrospectively reviewed records of patients who underwent an OJ at our institution between 2005 and 2014. Primary outcomes include operating time, length of hospital stay, time to feeding goals, and postoperative complications.
  
  
  RESULTS
  We identified 12 children (6 males) with multiple comorbidities who underwent OJ procedures. The median age at surgery was 11years (range 3months-23years). Eleven patients had failed previous alternative feeding access or antireflux procedures. All patients eventually reached their feeding goals. Eight were at goal feeds in <10days. Two achieved goal feeds <1month, one <4months, and one within 7months. There was one OJ failure because of fistula formation requiring surgical revision, and one child was treated successfully but died of unrelated causes. Four children eventually transitioned to PO or G-tube feeds, and six were tolerating feeds via OJ at last follow-up (8-74months).
  
  
  CONCLUSIONS
  OJ provides a durable alternative to gastrojejunostomy tube for patients who are poor candidates for or have failed Nissen fundoplication. It is technically easier to perform than a gastroesophageal disconnect procedure, has minimal surgical comorbidities, and can provide durable feeding access and achievement of goal feeds in a complex and refractory patient subset.
authors.affiliation: Akron Children's Hospital Department of Pediatric Surgery, USA. Electronic address: avi.schlager@gmail.com.
authors.forename: Avraham
authors.initials: A
authors.lastname: Schlager
authors.affiliation: Emory University Department of Surgery, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Arps
authors.affiliation: Emory University Department of Surgery, USA.
authors.forename: Ragavan
authors.initials: R
authors.lastname: Siddharthan
authors.affiliation: Emory University Department of Surgery, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Rajdev
authors.affiliation: Emory University/Children's Healthcare of Atlanta, USA.
authors.forename: Kurt F
authors.initials: KF
authors.lastname: Heiss
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D007582:Jejunostomy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Jejunostomy; Postpyloric feeding; Refractory reflux