Efficacy of double-point jejunostomy in laparoscopic surgery for esophageal cancer: a comparative study

Abstract

Background

Esophageal cancer is a malignant tumor prevalent worldwide, with its incidence rising annually, severely impacting patients’ quality of life and survival. Surgical resection remains one of the primary treatment modalities for esophageal cancer. However, the postoperative recovery process is frequently complicated by malnutrition. This nutritional deficiency not only delays the patient’s recovery but may also precipitate a series of complications, thereby further compromising the patient’s prognosis. Consequently, timely and effective nutritional support post-surgery is crucial for the rehabilitation of esophageal cancer patients. This study aimed to evaluate the efficacy of modified laparoscopic jejunojejunostomy in esophageal cancer resection and to compare it with conventional nasojejunal tube placement, assessing its advantages in reducing postoperative complications and improving patient nutritional support.

Methods

We retrospectively analyzed data from 123 patients who underwent fully laparoscopic esophageal cancer resection in the Department of Thoracic Surgery at The First Affiliated Hospital of Soochow University between December 2022 and June 2025. Patients were divided into a study group (double-anastomotic stoma, n=45) and a control group (nasojejunal tube placement, n=78) based on postoperative nutritional support methods. Perioperative nutritional indicators, postoperative recovery, complication rates, and feeding tube-related adverse events were compared between the two groups.

Results

There were no significant differences between the study group and the control group in terms of albumin levels, total protein levels, or changes in body mass index (BMI) before and after surgery (P>0.05). Only the albumin level measured three days after surgery was significant, with the two-point fistulization group performing better than the nutrition tube group. The postoperative hospital stay, fasting time, and tube retention time in the study group were significantly shorter than those in the control group (P<0.05). The feeding tube dropout rate in the study group was significantly lower than that in the control group (P<0.05). With regard to other complications, no significant differences were observed between the groups (P>0.05).

Conclusions

Laparoscopic double-point jejunostomy can effectively provide postoperative nutritional support, significantly reduce the risk of bowel obstruction and tube dislodgement, and improve the comfort of patient recovery after surgery. It is a safe and effective method of nutritional support, suitable for patients following total laparoscopic esophagectomy.

Highlight box.

Key findings

• The laparoscopic double-point jejunostomy technique effectively provided postoperative nutritional support, with nutritional outcomes (albumin, total protein, body-mass-index) comparable to those of the conventional nasojejunal tube group. The postoperative incidence of intestinal obstruction is lower in laparoscopic double-point jejunostomy, which may offer a distinct advantage over traditional jejunostomy.

What is known and what is new?

• Malnutrition is common in esophageal cancer patients postoperatively, and enteral nutrition is superior to parenteral nutrition. Traditional jejunostomy is associated with a risk of intestinal obstruction due to single-point fixation. Nasojejunal tubes are prone to dislodgement, affecting patient comfort and nutritional safety.

• This study introduces a modified double-point fixation technique for laparoscopic jejunostomy, which better maintains intestinal position and reduces mechanical complications. The present study demonstrates that this technique reduces tube dislodgement and intestinal obstruction without compromising nutritional efficacy.

What is the implication, and what should change now?

• The double-point jejunostomy technique is a safe, effective, and patient-friendly option for nutritional support after totally laparoscopic esophagectomy. Further prospective multicenter studies with larger sample sizes and longer follow-up are encouraged to validate long-term outcomes.

Introduction

Esophageal cancer is a globally prevalent malignant tumor with an increasing incidence rate, severely impacting patients’ quality of life and survival. Surgical resection remains a primary treatment modality for esophageal cancer (1). However, the postoperative recovery process is often complicated by malnutrition (2-4). This nutritional deficiency not only delays patient recovery but may also precipitate a series of complications, further compromising patient prognosis (5). Consequently, timely and effective postoperative nutritional support is crucial for the rehabilitation of esophageal cancer patients (6,7). Traditional nutritional support methods primarily include parenteral nutrition and enteral nutrition. Parenteral nutrition delivers nutrients via intravenous infusion to meet patients’ nutritional requirements (8,9). While it can rapidly provide essential nutrients in certain situations, long-term use may cause intestinal mucosal atrophy, thereby reducing mucosal function. Additionally, parenteral nutrition may disrupt gastrointestinal function and increase the risk of various complications, such as infections and liver damage. Simultaneously, parenteral nutrition offers limited delivery methods and carries high costs, imposing significant financial burdens on patients. In contrast, enteral nutrition is considered a more ideal nutritional support approach (10). By delivering nutrients directly to the intestines via oral intake or tube feeding, enteral nutrition better preserves intestinal barrier function, aligns with physiological needs and normal metabolism, and enhances intestinal immunity. Common enteral feeding methods primarily include nasojejunal feeding and jejunostomy, with the latter being a frequently used tube placement technique (11,12). The advantage of jejunostomy lies in bypassing potentially compromised oral and esophageal pathways, reducing gastrointestinal damage and adverse reactions during nutritional support. This ensures patients receive adequate nutrition during treatment, thereby improving quality of life (13). However, traditional jejunostomy procedures have certain limitations during implementation. The conventional approach involves single-point fixation of the proximal jejunum to the abdominal wall. This fixation method can easily cause the suspended intestinal segment to form angles or twist within the abdominal cavity, potentially leading to complications such as intestinal obstruction or intussusception (14). Studies indicate that the incidence of postoperative intestinal obstruction within five years after traditional jejunostomy can be as high as 12%. This high rate not only impairs patient, recovery but may necessitate reoperation, increasing patient suffering and financial burden. Therefore, improving jejunostomy techniques to reduce postoperative intestinal obstruction is crucial for enhancing the quality of life and prognosis of patients undergoing esophageal cancer surgery. Consequently, this study modified the fixation method for jejunostomy feeding tubes and compared its therapeutic outcomes with those of traditional gastrostomy feeding tubes in patients after esophageal cancer surgery. We present this article in accordance with the STROBE reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-aw-2124/rc).

Methods

Study population

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the institutional review board of The First Affiliated Hospital of Soochow University (ethical approval No. 2025985) and individual consent for this retrospective analysis was waived. We conducted a retrospective study of 123 patients who underwent fully laparoscopic esophageal cancer resection at the Department of Thoracic Surgery of The First Affiliated Hospital of Soochow University and its affiliated medical consortium hospitals between December 2022 and June 2025. Patients ranged in age from 53 to 80 years and had preoperative endoscopic pathological confirmation of esophageal squamous cell carcinoma. Patients were divided into a study group (n=45) and a control group (n=78) based on the postoperative enteral nutrition method. The study group underwent laparoscopic double-point jejunostomy during surgery, while the control group received nasojejunal tube placement. Inclusion criteria: (I) meeting the diagnostic criteria for esophageal cancer in the “Guidelines for the Treatment of Esophageal and Gastric Cancer”, with preoperative endoscopic pathological biopsy confirming esophageal cancer; (II) eligible for thoracoscopic esophagectomy; (III) no contraindications for radical esophageal resection; (IV) expected survival >6 months; (V) Karnofsky score ≥69; (VI) complete clinical data. Exclusion Criteria: (I) patients who underwent initial fully endoscopic surgery but later required conversion to open surgery; (II) patients receiving nutritional support via other tube placement methods or routes; (III) patients with a history of other gastrointestinal surgeries or major abdominal surgeries; (IV) patients unable to undergo a 6-month postoperative follow-up or with an estimated survival period of less than 6 months; (V) patients with severe concomitant respiratory, circulatory, or hematological diseases. This study was approved by the hospital’s ethics committee.

Surgical procedure

All procedures were performed by a technically proficient surgical team from the Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University. Patients underwent thoracoscopic-laparoscopic Ivor-Lewis procedures or laparoscopic right thoracic Ivor-Lewis procedures under general anesthesia. All patients were managed according to the Chinese Society of Clinical Oncology Guidelines for the Diagnosis and Treatment of Esophageal Cancer. Preoperative multidisciplinary team discussions ensured thorough evaluation and the acquisition of informed consent. Clinical staging determined the need for preoperative neoadjuvant therapy; multidisciplinary consultations were conducted when necessary to finalize treatment plans. Jejunostomy or gastrostomy-jejunostomy tube placement was performed concurrently with esophageal cancer resection. From postoperative recovery to discharge, patients were instructed daily to perform respiratory exercises, expectoration, and coughing to prevent aspiration. Discharge criteria were: (I) stable vital signs; (II) adequate pain control with oral analgesics; (III) semi-liquid diet intake; (IV) no requirement for intravenous fluids; (V) ambulation without assistance; (VI) absence of wound exudate, infection, or dehiscence. Esophageal resection and jejunal nasojejunal tube placement were successfully completed in all cases, without operative mortality.

The study group employed double-point jejunostomy as follows: After conventional laparoscopic esophagectomy and anastomosis, during jejunal nasojejunal tube placement, the transverse colon was first retracted with an intestinal clamp with non-traumatic teeth to expose the Treitz ligament. Starting approximately 20–30 cm distal to the Treitz ligament, the jejunum was sequentially examined distally. A segment of the jejunal loop with good mobility, clear mesenteric vessels, and no adhesions (typically located approximately 40–50 cm from the Treitz ligament) was selected as the planned stoma site. Laparoscopically, the proximal end of the jejunum at the stoma site is fixed to the peritoneal wall using non-absorbable sutures. A pre-selected abdominal stoma site is chosen in the left upper abdomen, typically corresponding to the primary working port location. At the pre-selected abdominal stoma site, the skin is incised with a scalpel to a length of approximately 0.5–1.0 cm. Under laparoscopic visualization, a straight needle with a suture is used to puncture vertically through the abdominal wall into the abdominal cavity, introducing the pre-loaded suture. Using a trocar, puncture the abdominal wall vertically into the abdominal cavity. Gently retract the intestinal wall at the jejunal stoma site with forceps and suture the abdominal wall into the seromuscular layer of the jejunal wall at this location, ensuring secure fixation without penetrating the intestinal mucosa. Puncture the pre-selected stoma site with a trocar to confirm entry into the intestinal lumen. Insert a jejunal feeding tube through the abdominal wall incision into the abdominal cavity, advancing the catheter tip approximately 15–20 cm into the distal jejunum. Using the same technique, secure a second suture approximately 5 cm distal to the first fixation point on the peritoneal wall, establishing a “double-point” fixation. Inject a small volume of saline through the catheter using a syringe. Observe the smooth flow without resistance and confirm that no fluid leaks into the abdominal cavity to verify correct catheter placement and patency. Securely knot the external fixation sutures to ensure that the jejunal wall adheres tightly to the peritoneum. Fix the feeding tube externally to the skin with an additional suture (Figure 1).

Figure 1.

Double-point jejunostomy procedure. (A) Secure the proximal jejunum to the parietal peritoneum adjacent to the puncture site. (B) Using a trocar, penetrate the abdominal wall vertically into the abdominal cavity. Gently elevate the jejunal wall at the stoma site with forceps, then suture the abdominal wall-attached suture to the seromuscular layer of the jejunal wall at this location. (C) Fix the trocar needle to puncture the jejunum through the abdominal wall. (D) Insert a jejunal feeding tube distally into the intestinal lumen, advancing it approximately 15–20 cm into the distal jejunum. (E) Fix the distal jejunum to the peritoneal wall again at 5 cm intervals. (F) Tighten the suture outside the abdominal cavity to secure the jejunum firmly to the abdominal wall.

The control group underwent nasogastric-jejunal tube placement. Specifically, after the stomach was mobilized and elevated into the thoracic cavity in preparation for anastomosis, the circulating nurse inserted the feeding tube through the patient’s nostril. The primary surgeon grasped the distal end of the feeding tube within the thoracic cavity and advanced it into the tubular stomach. The surgeon guided the tube with one hand within the abdominal cavity while slowly advancing it with the other. The gastric body is gently flattened, and the tube tip is directed toward the pylorus before being advanced into the descending part of the duodenum. The feeding tube is further advanced until its tip reaches the horizontal part of the duodenum and the beginning of the jejunum (approximately 20–30 cm beyond the ligament of Treitz). This entire process is performed under direct tactile guidance by the surgeon’s fingers, ensuring that the tube remains free of kinks or folds and enters the jejunum smoothly. The surgeon confirms by palpation that the feeding tube passes through the jejunum smoothly, with its distal end extending beyond the ligament of Treitz. Verify that the distal tip of the tube is positioned within the jejunum. The anesthesiologist securely fixes the feeding tube to the nasal wing and cheek area to prevent dislodgement during surgery, leaving approximately 55–60 cm of tubing outside the nasal cavity. This length may be adjusted based on the patient’s height and intraoperative conditions.

Data collection and observation Indicators

The data were gathered through an electronic medical record system, encompassing: (I) changes in nutritional indicators before, during, and after surgery: serum total protein, serum albumin, body mass index; (II) factors affecting patient comfort: postoperative fasting duration, postoperative tube retention time, postoperative hospitalization duration; (III) surgery-related complications: anastomotic fistula, pulmonary infection, chylothorax, empyema, wound healing infection, and nutritional tube dislodgement.

Statistical analysis

Data were analyzed using SPSS software (SPSS 25.0, Chicago, IL, USA). Enumeration data were presented as percentages and analyzed by χ² test or Fisher’s exact test., and measurement data were presented as mean ± standard deviation (SD) and analyzed by t-test. A P value ≤0.05 was considered statistically significant.

Results

Patient’s basic information

The double-point jejunostomy group comprised 45 patients (33 males and 12 females), with a mean age of 70.67 years (SD =8.06 years). Among the 78 patients in the feeding tube group, 57 were males and 21 were females. The mean age was 67.78 years (SD =6.81 years). In the double-point jejunostomy group, tumors were located in the middle esophagus in 39 patients (86.7%) and in the lower esophagus in 6 patients (13.3%). In the feeding tube group, 38 patients (48.7%) had tumors in the middle esophagus, 26 patients (33.3%) had tumors in the lower esophagus, and 14 patients (17.9%) had tumors in the upper esophagus. Regarding baseline characteristics, 7 patients (15.56%) in the double-point stoma group received preoperative adjuvant therapy (chemotherapy or chemotherapy plus immunotherapy), while 6 patients (7.69%) in the feeding tube group underwent preoperative adjuvant therapy. In the double-stoma group, 24 patients (53.3%) had hypertension and 6 patients (13.3%) had diabetes. In the feeding tube group, 32 patients (41.0%) had hypertension, and 6 patients (7.7%) had diabetes. Specific correlations are shown in Table 1. Among them, due to the differences in the incidence probabilities of esophageal cancer at various locations, the number of patients in certain tumor locations is small, which may potentially impact the results of this study (P<0.01). It is planned to study the sample size in the follow-up with regard to this effect. In addition, the control group (nutrition tube group) was slightly younger than the experimental group (double-point fistula group) (P=0.03), and no significant differences were observed in other characteristics.

Table 1. Baseline information of the enrolled patients.

Variable	Control group (n=78)	Observation group (n=45)	χ2/t	P
Sex			0.072	0.78
Male	57	33
Female	21	12
Age (years)	67.78±6.81	70.67±8.06	−2.113	0.03
Hypertension	32	24	1.802	0.17
Diabetes	6	6	0.934	0.33
Location			18.274	<0.001
Upper thoracic	14	0
Middle thoracic	38	39
Lower thoracic	26	6
TNM stage			0.132	0.93
I	25	15
II	33	18
III	20	12
Preoperative neoadjuvant chemotherapy	6	7	0.432	0.51

Data are presented as number or mean ± standard deviation. TNM, tumor, node, metastasis.

Comparison of preoperative and postoperative nutrition-related indicators between the two groups

To study the effect of two types of enteral nutrition on the nutritional status of patients with esophageal cancer after laparoscopic surgery, this study recorded changes in body mass index (BMI) both before and one week after surgery in both groups. It also recorded the levels of serum total protein and albumin, as well as their changes in both groups of patients before surgery, three days after surgery, and one week after surgery. It was found that the albumin level in the study group was higher on the third day after surgery compared to the control group. There was no significant difference in albumin and total protein levels between the two groups before surgery (P>0.05), and no significant difference in BMI between the two groups before and after surgery (P>0.05) (see Table 2).

Table 2. Nutritional status before and after the operation.

Variable	Control group (n=78)	Observation group (n=45)	t	P
Serum albumin (g/L)
Before	39.06±4.10	41.30±7.85	−1.76	0.08
After three days	38.56±3.67	37.02±3.87	2.19	0.03
After one week	36.73±4.46	37.30±4.53	−0.68	0.50
Total protein (g/L)
Before	66.31±6.22	67.88±13.86	−0.71	0.47
After three days	56.19±5.93	60.46±6.41	−1.10	0.27
After one week	59.92±7.10	58.43±4.39	1.44	0.15
BMI (kg/m2)
Before	24.53±2.84	24.68±3.27	−0.28	0.78
After one week	23.63±2.82	24.05±3.27	−0.74	0.46

Data are presented as mean ± standard deviation. BMI, body mass index.

Comparison of comfort-related indicators between the two groups

The study group demonstrated significantly better outcomes than the control group in three key indicators: postoperative hospital stay, postoperative fasting duration, and postoperative catheterization duration. These differences were statistically significant (P<0.05), as shown in Table 3.

Table 3. Comparison of postoperative recovery.

Times	Control group (n=78)	Observation group (n=45)	t	P
Postoperative nutrition tube time (days)	23.49±11.68	17.40±9.28	3.18	0.02
Postoperative fasting time (days)	21.38±11.22	13.71±6.81	4.16	<0.01
Postoperative hospital stay (days)	24.59±11.47	18.87±8.73	3.11	0.02

Data are presented as mean ± standard deviation.

Comparison of surgical complications

Common postoperative complications in esophageal cancer patients were statistically analyzed for both groups, including anastomotic fistula, pulmonary infection, pleural effusion, intestinal obstruction, and chylothorax. The experimental group exhibited a 0% rate of feeding tube dislodgement, which was significantly lower than that of the control group (19.23%, P<0.05). However, no significant differences were observed between the experimental and control groups for other common complications following fully laparoscopic esophageal cancer surgery (see Table 4). Notably, none of the 45 patients in the experimental group who underwent double-stoma creation developed postoperative intestinal obstruction. This finding contradicts the traditional view that jejunal stoma creation is more prone to intestinal obstruction than nasojejunal tube placement, and it also highlights a potential advantage that we hope to emphasize and promote for this technique.

Table 4. Comparison of complications.

Complications	Control group (n=78)	Observation group (n=45)	χ2	P
Pulmonary infection	11 (14.10)	3 (6.67)	1.564	0.25
Incision infection	2 (2.56)	0	–	0.53
Pleural effusion	11 (14.10)	5(11.11)	0.226	0.63
Intestinal obstruction	0	13 (16.67)	–	0.002
Nutrition tube detachment	0	15 (19.23)	9.856	0.002
Anastomotic leakage	1 (2.38)	2 (3.45)	0.018	0.77

Data are presented as n (%).

Discussion

Dysphagia is the most common clinical symptom of esophageal cancer, and most patients discover the disease only after symptoms appear. Consequently, the majority of patients already suffer from malnutrition prior to surgery. Most esophageal cancer patients undergo neoadjuvant therapy and immunotherapy before surgery, and studies indicate that most patients experience decreased appetite following these treatments (15,16). Additionally, after surgery, patients experience significantly increased energy expenditure compared to preoperative levels due to the combined effects of surgery and postoperative stress (17,18). Consequently, most postoperative esophageal cancer patients face significant postoperative nutritional risks. Selecting an appropriate postoperative nutritional support strategy holds critical clinical importance for patient recovery and prognosis (19,20). Furthermore, with advances in medical care, postoperative survival periods for esophageal cancer patients continue to extend. While pursuing treatment efficacy, clinicians and patients increasingly prioritize postoperative recovery speed and comfort. In clinical practice, mainstream postoperative nutritional support methods are broadly categorized into enteral and parenteral nutrition (21). Long-term parenteral nutrition may reduce intestinal cell DNA content during use, diminishing protein synthesis capacity. This further leads to mucosal atrophy, lowering intestinal mucosal activity, causing gastrointestinal dysfunction, and increasing susceptibility to various complications. Additionally, parenteral nutrition offers limited dietary variety and is costly (22). Enteral nutrition is increasingly adopted clinically, delivering nutritional support via oral intake or tube feeding. Typically administered as liquid diets, it is more readily absorbed by the gastrointestinal tract. Compared to parenteral nutrition, enteral nutrition helps maintain the normal structure of intestinal mucosal cells, better protects the intestinal barrier function, and more closely aligns with human physiological needs and normal metabolism. By delivering nutrient solutions directly into the intestines, enteral nutrition stimulates gastrointestinal motility, activates the intestinal endocrine system, and further promotes the synthesis and release of gastrointestinal hormones. This increases blood flow, restores normal function, and enhances immunity (23). Mainstream enteral nutrition primarily employs two methods: gastroduodenal feeding tubes and jejunostomy (13). While gastroduodenal feeding tubes offer advantages such as relatively fewer postoperative complications, their passage through the patient’s oral cavity and digestive tract leads to more adverse reactions and lower patient comfort. Additionally, they are typically secured with medical tape, making them prone to accidental removal by patients in an unconscious state postoperatively. In recent years, with technological advancements, the technique of placing gastric tubes via interventional radiology using digital subtraction angiography (DSA) has gained traction. However, it carries drawbacks such as high cost and stringent requirements for the operating environment. While effective in patients with pronounced symptoms like esophageal stricture, it is not typically the first-line choice (24).

In contrast, jejunostomy involves creating a stoma in the abdominal wall, allowing the feeding tube to bypass the oral cavity and digestive tract. Compared to patients undergoing nasojejunal tube placement, perioperative complications such as postoperative discomfort, coughing, and vomiting may lead to tube dislodgement. Relevant literature indicates that the tube dislodgement rate after nasojejunal tube placement reaches 20–30%, whereas the dislodgement rate for jejunostomy is only approximately 2.8%. This data also relatively reflect that jejunostomy has a lesser impact on patient comfort during tube placement and hospitalization, making it more tolerable for patients (12). Most relevant studies indicate that patients undergoing jejunostomy experience significantly better postoperative outcomes than those who receive nasojejunal tube placement. Concurrently, anastomotic fistula is one of the most common complications following esophageal cancer surgery, with upper gastrointestinal contrast studies being the primary method for detecting such fistulas postoperatively (25). However, in patients with nasojejunal tube placement, the presence of the esophageal feeding tube can obstruct smaller fistulas during radiography, preventing their visualization. This phenomenon reduces the postoperative detection rate of anastomotic fistulas and negatively affects patient recovery (14). Additionally, although studies indicate that superficial jejunal tube placement inevitably increases the risk of postoperative wound infection due to the additional surgical incision, this can be mitigated through enhanced wound care and judicious use of prophylactic antibiotics (26). Furthermore, traditional jejunostomy, due to single-point suspension, predisposes the intestine to angulation or torsion within the abdominal cavity during nutritional support, thereby increasing susceptibility to complications such as intestinal obstruction and intussusception. The modified double-point stoma technique employs dual suspension points to maintain the intestine in a position closer to its physiological curvature during nutritional support. This significantly preserves intestinal compliance, prevents postoperative displacement and angulation within the abdominal cavity, and reduces the incidence of postoperative intestinal obstruction. Additionally, the presence of dual suspension points substantially increases intestinal stability within the abdominal cavity, significantly reducing the incidence of postoperative alleviates patient discomfort (27). Furthermore, the postoperative nutritional support efficacy achieved with this technique shows no significant difference compared to nasojejunal feeding tubes. There are some limitations in this study: (I) it is a retrospective, single-center study, and the results may be subject to selection bias. (II) The relatively small sample size, limited to esophageal cancer patients, and short follow-up period result in insufficient representativeness. (III) Nutritional status assessments, primarily reflecting perioperative conditions at 3 days and 2 weeks post-surgery, may not accurately reflect long-term nutritional outcomes, necessitating further investigation. (IV) This study only examined the impact of postoperative enteral nutrition support on nutritional indicators and did not include the role of parenteral nutrition (such as the intravenous infusion of human serum albumin). Although patients were given standardized parenteral nutrition support after surgery, this may still introduce some bias into the results. (V) Regarding the assessment of postoperative patient comfort, some objective indicators used in this study may not fully reflect the patients’ subjective experiences. Despite these limitations, we believe that, compared to gastroduodenal tube placement, double-end jejunostomy offers comparable nutritional support while reducing the incidence of postoperative complications such as intestinal obstruction and tube dislodgement. It does not significantly increase the incidence of other postoperative complications. Therefore, it remains a safer and more effective nutritional support option for patients undergoing fully laparoscopic esophageal cancer surgery and warrants further promotion.

Conclusions

Compared with other postoperative nutritional support strategies for patients undergoing total laparoscopic esophageal cancer resection, double-point jejunostomy effectively provides the necessary nutrition for them. Its efficacy is comparable to that of traditional jejunostomy, while reducing the incidence of postoperative intestinal complications, such as intestinal obstruction. Furthermore, it does not significantly increase the incidence of other surgery-related complications. In terms of patient comfort, shorter tube retention time and lower tube dislodgement rates further highlight the advantages of this postoperative nutritional support approach, indicating greater patient acceptance of this stoma creation method. Overall, double-point jejunostomy represents a safe and effective method of nutritional support following fully laparoscopic esophagectomy.

Supplementary

The article’s supplementary files as

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the institutional review board of The First Affiliated Hospital of Soochow University (ethical approval No. 2025985) and individual consent for this retrospective analysis was waived.

Data Sharing Statement

Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-aw-2124/dss

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DOI: 10.21037/jtd-2025-aw-2124