Roux-en-Y jejunostomy in the pediatric population

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.