A Safe and Reliable Method of Laparoscopic Feeding Jejunostomy Tube Placement

Abstract

This streaming video demonstrates our technique of laparoscopic placement of feeding jejunostomy tube. This technique can be employed before any upper gastrointestinal surgery. In our practice, we use this in patients diagnosed with gastroesophageal junction or esophageal cancer with obstructing symptoms and weight loss before instituting neoadjuvant therapy. This approach has manifold advantages. Same ports can be utilized subsequently for a minimally invasive esophagectomy, and the jejunostomy tube does not hinder the visualization throughout the procedure. Pre-therapy, this serves as a staging procedure combined with other modalities, provides enteral access, and optimizes nutritional status during the neoadjuvant treatment. From a technical standpoint, this mimics the steps of an open procedure and secures the jejunum to the abdominal wall under direct visualization. The prefashioned 16F T-tube minimizes the risk of clogging. The proximal and distal transfacial sutures avoid any torsion around the tube exit site. In conclusion, laparoscopic feeding jejunostomy, utilizing the technique demonstrated, is a safe and effective strategy that can be utilized before any upper gastrointestinal surgery, especially minimally invasive esophagectomy.

Dr. Steven N. Hochwald is a consultant to Ethicon Endo-Surgery. Dr. Moshim Kukar has no conflicts of interest or financial ties to disclose.

Runtime of video: 8 mins 15 secs