Laparoscopic Button Loop Feed Jejunostomy

Abstract

Purpose:

The purpose of this procedure is to provide a minimally invasive feeding access technique in patients in whom oral or intragastric nutrition is not an option. Surgically placed feeding jejunostomies allow patients to receive postpyloric enteral nutrition in a tolerable and safe manner. At our institution, we designed a minimally invasive technique to place feeding jejunostomies that is not only simple but also more importantly safe and effective. This 2-minute video demonstrates the technique for placing a button loop-feeding jejunostomy in the pediatric population.

Methods:

The surgical technique entails accessing the abdomen with a 3/5-mm scope at the umbilicus, placing a 12-mm port in the right side of the abdomen, and placing a second working 3/5-mm port in the right-lower quadrant. The right side of the abdomen is chosen as most of our patients have a gastrostomy tube in the left-upper abdomen. The patient is placed in reverse trendelenberg, and the small bowel is displaced into the lower abdomen. The transverse colon is elevated, allowing identification of the ligament of treitz. Approximately 15 to 20 cm from the ligament of treitz, the jejunum is exteriorized through the 12-mm-port site. The jejunum is folded onto itself. Guy sutures are placed distally. A purse-string suture is placed at the apex. An enterotomy is made. An endoscopic stapler is inserted into the limbs of the jejunum. If an endoscopic stapler is used, two staple fires should be utilized to ensure an adequate channel length. If a gastrointestinal anastomosis stapler is utilized, a single cartridge may be utilized. An extracorporeal side‐to‐side anastomosis is performed. A MicKey button is inserted, and the purse-string suture is secured. Anchor sutures are placed onto the peritoneum and secured in the same manner as a Stamm gastrostomy tube.

Results:

Tube feeds are initiated in 8–12 hours and increased to goal volume within the first 24 hours. The first tube change may be performed on the same schedule as that of a Stamm gastrostomy tube.

Conclusion:

We believe that our laparoscopically placed loop-feeding jejunostomy tube is a safe and effective means of establishing a permanent feeding access in patients who are unable to tolerate oral or intragastric feeds. This technique may reduce the risks of bowel obstruction and intussusceptions. It allows for safer access by our interventional radiology colleagues in the event of premature tube dislodgement. It also obviates tube complications such as tube migration and occlusion.

No competing financial interests exist.

Runtime of video: 2 mins