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Roux-en-Y jejunostomy in the pediatric population
N R Yoshida1, E M Webber, D A Gillis
1Izaak Walton Killam Hospital for Sick Children, Halifax, Nova Scotia, Canada.
Insights
The modified Maydl approach for Roux-en-Y jejunostomy feeding tubes is preferred over the Brook-style due to fewer reoperations for complications like prolapse and leakage in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Nutrition
Background:
- Surgical nutrition access is crucial for pediatric disorders, with jejunostomy often preferred over other methods.
- Gastroesophageal reflux, delayed gastric emptying, and fundoplication risks influence the choice of jejunostomy.
- Roux-en-Y jejunostomy configuration mitigates issues associated with simple loop jejunostomy.
Purpose of the Study:
- To compare the outcomes of two Roux-en-Y jejunostomy stoma types: Brook-style and modified Maydl (Stamm-style).
- To evaluate complication rates and identify the preferred method for pediatric feeding jejunostomy at the authors' institution.
Main Methods:
- Retrospective review of 22 Roux-en-Y jejunostomies performed over 27 months.
- Comparison between Brook-style (intubatable) and modified Maydl (permanently intubated) stoma types.
- Analysis of significant complications requiring reoperation for each stoma type.
Main Results:
- Three (33%) patients with Brook-style jejunostomies required reoperation for prolapse, leakage, or perforation.
- No patients with modified Maydl jejunostomies required reoperation, though stoma care challenges were noted.
- The modified Maydl approach demonstrated a lower rate of severe complications necessitating surgical intervention.
Conclusions:
- The modified Maydl approach for Roux-en-Y jejunostomy is associated with fewer significant complications requiring reoperation compared to the Brook-style.
- The modified Maydl approach is the preferred method for creating feeding jejunostomies in pediatric patients at this institution.
- While the modified Maydl stoma requires careful management, its safety profile regarding major complications is superior.
Abstract:
Surgical access for nutrition is required in a variety of pediatric disorders. In some, the presence of gastroesophageal reflux, poor gastric emptying, and risks for fundoplication favor the use of a jejunostomy. The significant problems associated with the simple loop jejunostomy can be avoided by using the Roux-en-Y configuration. The stoma can be fashioned either Brook-style (intubatable) or Stamm-style (modified Maydl, permanently intubated). Both types are used at the authors' institution and are compared in this retrospective review. During a 27-month period, 22 Roux-en-Y jejunostomies were performed; nine of them had the Brook-style stoma and 13 had the modified Maydl stoma. Significant complications requiring reoperation occurred in three (33%) patients with a Brook-style jejunostomy: prolapse, leakage, and perforation of the stoma. None of the patients with modified Maydl jejunostomies required reoperation; problems were encountered more with the care of the permanently intubated stoma. Therefore, our preferred choice for a feeding jejunostomy is the modified Maydl approach.