BACKGROUND
Laparoscopic insertion of a feeding jejunostomy is a common but technically demanding operation. One of the most difficult aspects is the percutaneous cannulation of the jejunum. While previous authors have described techniques involving laparoscopic insertion of a purse string suture around the entry site of the jejunum,1 this can be technically challenging and time consuming. We describe our experience of a simple technique for this step in the procedure.
TECHNIQUE
A 2/0 polyglactin suture on a straight needle is inserted through a 2mm skin incision into the peritoneal cavity and two separate bites are made on the antimesenteric border of the proximal loop of bowel. A suture passer is then used to pull the needle out through the skin incision. This technique is repeated on a distal segment of bowel. The two sutures are pulled up towards the abdominal wall and the metal introducer for the feeding catheter inserted through the abdominal wall (Fig 1). The jejunum is then cannulated under vision with the two sutures held under tension to prevent the bowel from falling away from the anterior abdominal wall. The feeding catheter is inserted under vision to ensure the catheter is advanced distally and the sutures are tied transfascially, allowing the feeding tube to lie in a snug tunnel.
Figure 1.
Cannulation of the jejunum with the proximal and distal segments of bowel suspended under tension between two transfascial sutures
Between April and August 2010 this technique was performed on 19 consecutive patients with no tube-related complications or blockages.
DISCUSSION
Our technique obviates the need for laparoscopic suturing and is quick, simple and effective.
Reference
- 1.Mistry RC, Mehta SS, Karimundackal G, Pramesh CS. Novel cost-effective method of laparoscopic feeding-jejunostomy. J Minim Access Surg. 2009;5:43–46. doi: 10.4103/0972-9941.55108. [DOI] [PMC free article] [PubMed] [Google Scholar]