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Laparoscopic gastrostomy and jejunostomy are safe and effective for obtaining enteral access
K M Murayama1, T J Johnson, J S Thompson
1Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280, USA.
Background:
Laparoscopic gastrostomy (lap g-tube) and jejunostomy (lap j-tube) are relatively new procedures that do not require laparotomy. Our aim was to determine the role of laparoscopic feeding tube placement for enteral access and the safety of these techniques.
Methods:
We reviewed our experience with attempted laparoscopic placement of 93 enteral tubes in 81 patients over a 3-year period. Patients received either a lap g-tube (n = 64), lap j-tube (n = 5), or both lap g/j-tube (n = 12). When enteral access was needed for nutritional support, the choice of lap g-tube or lap j-tube was based on risk of gastroesophageal reflux.
Results:
The most common underlying conditions requiring tube placement were head and neck cancer (49%), neurologic disorders (19%), and trauma (11%). Mean operative times (minutes) were as follows (mean +/- SD): lap g-tube (39 +/- 7), lap j-tube (63 +/- 10), and lap g/j-tube (85 +/- 13). Lap g-tube placement was successful in 73 (96%) of 76 patients and lap j-tube in all 17 patients. The major complication rate for all tubes was 8% (7 of 93) and included gastrointestinal bleeding, wound infection, and failed placement. Five patients died in the 30-day period following surgery, but none of the deaths was procedure related.
Conclusions:
Laparoscopic tube placement should be considered for patients in whom endoscopy is not feasible or undesirable or who are undergoing other operative procedures. Lap g-tube and lap j-tube are safe procedures that avoid the potential risk of a laparotomy, and they can be done with a high success rate. This is a valuable approach for patients with head and neck cancer or neurologic disorders and for trauma patients with multiple disease processes.