Laparoscopic and open feeding jejunostomy in upper gastrointestinal pathology: a single-centre cohort study

Feeding jejunostomy (FJ) provides critical enteral access for patients undergoing treatment for upper gastrointestinal (GI) pathology. This study aimed to evaluate the safety, complication profile, and operative context of laparoscopic versus open FJ using a standardised laparoscopic technique.

A retrospective cohort study included 576 patients who underwent FJ between March 2018 and August 2024 (302 laparoscopic, 274 open). Patient demographics, operative context, and postoperative complications were analysed. Outcomes are reported as frequencies with relative effect estimates and corresponding 95% confidence intervals.

Baseline characteristics were comparable between groups. Laparoscopic FJ was more frequently performed in the elective setting (286/302 vs. 225/274; OR 3.88, 95% CI 2.20-6.85) and during cancer staging procedures (102/302 vs. 50/274; OR 2.28, 95% CI 1.55-3.37). In contrast, laparoscopic FJ was less commonly undertaken during major resections (156/302 vs. 165/274; OR 0.71, 95% CI 0.51-0.98) and emergency surgery (16/302 vs. 49/274; OR 0.25, 95% CI 0.14-0.45). On unadjusted analysis, overall postoperative complications were more frequent following laparoscopic FJ (43/302, 14.2%) compared with open FJ (18/274, 6.5%); however, after adjustment for comorbidity burden, procedural urgency, and other clinically relevant covariates, surgical approach was not independently associated with postoperative morbidity (adjusted OR 1.25, 95% CI 0.75-2.05). Tube-related complications, including dislodgement, leakage, and small bowel obstruction, were infrequent. Lower body mass index and female sex were associated with increased odds of obstruction. Early infectious complications occurred exclusively following laparoscopic FJ (5/302, 1.7%), but this association did not persist after multivariable adjustment (adjusted OR 2.60, 95% CI 0.75-9.10).

Laparoscopic FJ was a safe alternative to open insertion. Although unadjusted complication rates were higher following laparoscopic FJ, surgical approach was not independently associated with early morbidity after risk adjustment, supporting the use of minimally invasive techniques in appropriately selected patients.