Relaparotomy following complications of feeding jejunostomy in esophageal surgery

After recognition of the importance of early postoperative enteral feeding, placement of a feeding jejunostomy as an adjunct to gastrointestinal surgery has become widely accepted. However, little attention has been paid to surgical complications and their consequences. Feeding jejunostomy as an adjunct to esophageal resection and reconstruction can lead to serious surgical complications.

Between 1978 and 2000, 1,387 patients underwent esophageal resection and reconstruction. Of these, 1,166 patients received a needle catheter feeding jejunostomy at the end of the operation. All postoperative complications were prospectively evaluated in a database including surgical complications related to the feeding jejunostomy.

Overall, surgical complications occurred in 36%. There were 13 (1.1%) feeding jejunostomy related complications leading to relaparotomy. Of these, intraperitoneal leakage was the most common complication (n=5). Other jejunostomy-related complications included dislodgement (n=4), herniation (n=3) and torsion (n=1). Five patients (0.4%) died despite relaparotomy.

Feeding jejunostomy as an adjunct to esophageal resection and reconstruction can lead to serious surgical complications. Preventive measures have not resulted in a decrease in complication rate. Complications of leakage necessitating relaparotomy are associated with a high mortality rate. Therefore, other means of enteral access should be considered.