Related Experiment Video
Updated: Oct 10, 2025
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Is Roux-en-Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes
Paul S Cullis1,2, Rheanan E Buckle3, Paul D Losty4,5
1Department of Surgical Paediatrics, Royal Hospital for Children and Young People, Edinburgh.
Insights
Roux-en-Y jejunostomy (REYJ) can establish enteral autonomy in children but carries significant risks. Complications affect up to 50% of patients, with a 23% mortality rate, necessitating careful patient counseling.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Support
Background:
- Roux-en-Y jejunostomy (REYJ) is utilized for feeding in pediatric patients with foregut dysmotility or severe gastro-esophageal reflux disease (GERD).
- Concerns exist regarding the safety and efficacy of REYJ in this vulnerable population.
- Evaluating outcomes is crucial for determining its suitability in achieving enteral autonomy.
Purpose of the Study:
- To systematically review the outcomes of Roux-en-Y jejunostomy (REYJ) in children.
- To assess the safety and efficacy of REYJ for achieving enteral autonomy in pediatric patients with complex nutritional needs.
Main Methods:
- A PRISMA-adherent systematic review was conducted, searching Embase, CINAHL, and Medline databases.
- Methodological quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) and a bespoke system.
- Ten studies involving 164 pediatric patients were included.
Main Results:
- The methodological quality of included studies was generally poor.
- Most patients achieved enteral autonomy, though data on feeding progression and length of stay were inadequate.
- Seventy-six complications were reported, including peristomal leakage, internal hernia/volvulus, and surgical site infections. Thirty-eight patients died during follow-up.
Conclusions:
- Roux-en-Y jejunostomy (REYJ) can achieve enteral autonomy in children.
- However, up to 50% of patients experience complications, and 23% die during follow-up, often due to comorbidities.
- Parents and caregivers require thorough counseling regarding the risks and benefits of REYJ.
Objectives:
Roux-en-Y jejunostomy (REYJ) may establish feeding in children with foregut dysmotility or severe gastro-esophageal reflux disease (GERD). Nevertheless, concerns have been raised about safety and efficacy. We, therefore, evaluated outcomes of REYJ by systematic review to determine if this was a satisfactory option for achieving enteral autonomy in children with complex nutritional needs.
Methods:
A PRISMA-adherent systematic review was conducted of studies reporting children undergoing feeding REYJ. Two authors performed processes independently; the senior author resolved disagreements. Embase, CINAHL and Medline were searched (inception-01/21). Additional databases, references, and 'grey' literature were searched. Methodological Index for Non-randomized Studies (MINORS) and a bespoke system assessed methodological quality.
Results:
Of 362 articles, 10 met eligibility criteria (9 retrospective series; 1 conference proceeding). Unpublished data were also attained. Interobserver agreement for MINORS (kappa = 0.47) and bespoke scoring (kappa = 0.58) were moderate. After consensus, median MINORS score was 37.5% (IQR 6.3%) and bespoke 50% (IQR 20.8%), indicating poor methodological quality. One hundred sixty-four patients were reported (age range: 2 months to 19 years). Time to full feeds and length of stay were inadequately reported but most achieved enteral autonomy. No studies reported patient/caregiver-questionnaires. Seventy-six complications were documented (Clavien-Dindo grading was infeasible). Morbidity included peristomal leakage (N = 26), internal hernia/volvulus (N = 8), and SSI (N = 7). Thirty-eight patients died (2 procedure-attributable) during follow-up (range: 1 month to 15 years).
Conclusions:
Up to 50% patients experience complications after REYJ (often minor) with 23% patients dying during follow-up, often comorbidity-attributable. REYJ can achieve enteral autonomy although parents/caregivers of children should be counselled accordingly.
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...