Vertical distance from navel as a risk factor for bowel obstruction associated with feeding jejunostomy after esophagectomy: a retrospective cohort study

BMC Gastroenterology

Eisaku Ito¹  Norihiko Suzuki¹  Satoshi Narihiro¹  Hironori Ohdaira¹  Junji Takahashi¹  Hideyuki Takeuchi¹  Rui Marukuchi¹  Yutaka Suzuki¹  Teppei Kamada¹  Sojun Hoshimoto¹  Masashi Yoshida¹  Mitsuyoshi Urashima² 

[1] Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi329-2763, Nasushiobara City, Tochigi, Japan;Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan;

关键词: Bowel obstruction;    Feeding jejunostomy;    Esophageal cancer;    Esophagectomy;    Complications;   

DOI  :  10.1186/s12876-020-01506-6

来源: Springer

【 摘 要 】

BackgroundPlacement of feeding jejunostomy (PFJ) during esophagectomy is an effective method to maintain adequate nutrition, but is associated with serious complications such as bowel obstruction and jejunal torsion. The purpose of the current study was to analyze the incidence, clinical features, and risk factors of bowel obstruction associated with feeding jejunostomy (BOFJ) after PFJ.MethodsThis was a retrospective cohort study of 70 patients who underwent esophagectomy with three-field lymph node dissection for esophageal cancer and treated with PFJ between March 2013 and December 2019 in our hospital. Abdominal dissection was performed under hand-assisted laparoscopic surgery (HALS) from March 2013 to March 2015, and was changed to complete laparoscopic surgery in April 2015. We compared patients with and without BOFJ, and the incidence of BOFJ was evaluated. The primary endpoint was incidence of BOFJ after PFJ.ResultsSix patients (8.5%) were diagnosed with BOFJ, all of whom were symptomatic and in the HALS group. In addition, 3 cases displayed histories of recurrent BOFJ (3, 3, and 5 times). Laparotomy was performed in all cases. Subgroup analysis of the HALS group showed a significant difference only in straight-line distance between the jejunostomy and navel as a significant pre- and perioperative factor (117 mm [101–130 mm] vs. 89 mm [51–150 mm], p < 0.001). Furthermore, dividing straight-line distance between the jejunostomy and navel into VD and HD, only VD differed significantly (107 mm [93–120 mm] vs. 79 mm [28–135 mm], p = 0.010), not HD (48 mm [40–59 mm] vs. 46 mm [22–60 mm], p = 0.199).ConclusionsVD between the jejunostomy and navel was associated with BOFJ after PFJ with HALS esophagectomy. PFJ < 9 cm above the navel during HALS esophagectomy might effectively prevent BOFJ.

【 授权许可】

CC BY