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Laparoscopic Roux-en-Y feeding jejunostomy as a long-term solution for severe feeding problems in children
H van Braak1, R R Gorter1, M P van Wijk2
1Department of Pediatric Surgery, Amsterdam University Medical Center, Noord-Holland, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Insights
Laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) offers a safe, minimally invasive option for children with gastric emptying disorders. While minor complications occur, LRFJ provides definitive enteral feeding with high parental satisfaction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Enteral feeding is challenging for pediatric patients with gastric emptying disorders, often leading to complications with traditional methods.
- Existing alternatives like open jejunostomy or Roux-en-Y jejunostomy are either invasive or associated with significant complications.
- Limited data exists on the efficacy and safety of laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) in this population.
Purpose of the Study:
- To evaluate the outcomes of the laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) procedure in children with oral feeding intolerance due to delayed gastric emptying.
- To assess complication rates (short and long-term) and parental satisfaction following LRFJ.
Main Methods:
- Retrospective case-series analysis of pediatric patients (0-18 years) who underwent LRFJ.
- Data collected on LRFJ procedures performed between August 2011 and December 2020.
- Evaluation of complication incidence, severity (Clavien-Dindo classification), and parental satisfaction.
Main Results:
- Twelve pediatric patients underwent LRFJ for delayed gastric emptying.
- A total of 16 complications were observed in 8 out of 12 patients (67%).
- Complication severity included 13 Grade I, 1 Grade II, and 2 Grade IIIB (Clavien-Dindo). Parental satisfaction was high, with 11 out of 12 families satisfied.
Conclusions:
- LRFJ is a safe and effective minimally invasive technique for definitive enteral feeding in children with gastric emptying disorders.
- Despite common minor complications, LRFJ leads to high parental satisfaction and resolves oral feeding intolerance.
- LRFJ represents a valuable alternative to traditional and more invasive feeding methods in pediatric patients.
Abstract:
Enteral feeding is a common problem in children with gastric emptying disorders. Traditional feeding methods in these patients often show a high rate of complications and maintenance issues. Laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) has been described in a few patients as a minimal invasive option for enteral access in these children. The aim of this study is to evaluate the outcomes of the LRFJ procedure in our tertiary referral center. We conducted a retrospective case-series including all patients, aged 0-18 years old, that underwent a LFRJ procedure between August 2011 and December 2020 for the indication of oral feeding intolerance due to delayed gastric emptying. Outcomes evaluated were complications (short and long term) and parenteral satisfaction. In total, 12 children were identified that underwent LRFJ for the indication of oral feeding intolerance due to delayed gastric emptying. A total of 16 complications were noted in 8/12 patients (67%). Severity classified by Clavien-Dindo were grade I (n = 13), grade II (n = 1), and grade IIIB (n = 2). In 11/12 patients, parents were satisfied with the results.
Conclusions:
Although minor complications after LRFJ are common in our patients, this technique is a safe solution in patients with gastric emptying disorders leading to a definitive method of enteral feeding and high parenteral satisfaction.
What Is Known:
• Traditional tube feeding in children (duodenal, PEG-J-tubes) with severe delayed gastric emptying can be challenging with a high rate of complications and maintenance issues. • Open loop jejunostomy and Roux-en-Y jejunostomy are alternative, permanent methods of feeding but either invasive or are accompanied by severe complications. Little is known in the literature about laparoscopic Roux-en-Y feeding jejunostomy.
What Is New:
• Laparoscopic Roux-en-Y feeding jejunostomy is a permanent, safe and minimal invasive alternative option for enteral feeding in children with severe delayed gastric emptying..
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