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A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child
B F Gilchrist1, F I Luks, F G DeLuca
1Division of Pediatric Surgery, Brown University School of Medicine, Providence, RI 02903, USA.
Insights
Roux-en-Y jejunostomy may benefit neurologically impaired children needing feeding tubes, offering an alternative to fundoplication. However, jejunostomy tube plugging and dislodgment are common complications requiring intervention.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Nutrition
Background:
- Children with severe neurological deficits often require feeding tube access and antireflux procedures.
- Fundoplication, a common antireflux procedure, has high complication and failure rates (40-50%) in this population.
Purpose of the Study:
- To evaluate the efficacy and complications of Roux-en-Y jejunostomy for feeding access in neurologically impaired children.
- To assess its utility as an alternative to fundoplication, especially after failed antireflux procedures.
Main Methods:
- A retrospective review of 12 Roux-en-Y jejunostomies performed over a 6-month period (December 1993).
- All patients had documented gastroesophageal reflux; one had a prior failed Nissen fundoplication.
- Postoperative follow-up was conducted for 12 months.
Main Results:
- No deaths occurred. One patient needed stoma revision for prolapse; another required reoperation for tube dislodgement.
- Eight of the 12 patients experienced jejunostomy tube plugging or dislodgement, necessitating outpatient procedures for correction.
- No significant oral feeding was achieved in these patients.
Conclusions:
- Roux-en-Y jejunostomy can be a beneficial option for neurologically impaired children unable to ingest significant calories orally.
- It may serve as a useful alternative following failed fundoplication.
- Jejunostomy tube plugging and dislodgement are the primary postoperative concerns, often requiring radiographic confirmation for tube repositioning.
Purpose:
Feeding tube access with an antireflux procedure is frequently necessary in children with severe neurological deficits. Fundoplication in this particular group of patients has many complications and a reported failure rate of 40% to 50%. Recently, the use of a feeding Roux-en-Y jejunostomy has been advocated in this population.
Methods:
Since December 1993, over a 6-month period, the authors performed 12 Roux-en-Y jejunostomies. All children had documented gastroesophageal reflux. One patient had a prior failed Nissen fundoplication, and none of these patients were feeding significantly by mouth. Postoperative follow-up has been 12 months.
Results:
There were no deaths in this series. One patient required early revision of the stoma because of marked prolapse. One 11-month-old infant required reoperation 7 days postoperatively because of tube dislodgment. Eight of the 12 patients required out-patient procedures to unplug or replace the jejunostomy tube.
Conclusion:
The operation may be beneficial in a subset of neurologically impaired children who will never be able to ingest significant calories by mouth. It may also be useful after a failed fundoplication. The main postoperative complications were plugging and dislodgment of the jejunostomy tube, which if they occurred early, required x-ray confirmation for catheter placement.