Laparoscopic jejunostomy in malnourished surgical patients: indications and technique

Laparoscopic jejunostomy (LJ) represents a new way of enteral nutrition (EN) for surgical malnourished patients. LJ is an alternative form of therapy, with restricted indications to the few cases when classical way for EN (nosogastroenteral tube feeding, PEG/PEJ, surgical gastrostomy), are contraindicated or can not be used, and the patient is unable to eat. This technique is also preferred to the open surgical jejunostomy. The paper describes our LJ technique, indications and contraindications. We used JL in two surgical severely malnourished patients, within 11 and 14 days, before the elective, open, curative operations. In this period the patients where exclusively nourished with special feeding solutions through the LJ catheter. The main pathologic lesions were: extrinsec antral obstruction from a perforated transverse colon carcinoma in the omental pouch, in the first case, and proximal inflammatory stenosis of efferent loop, after gastric resection with Billroth II anastomosis for duodenal ulcer, in the second case. LJ gives the opportunity for the exploration of the whole abdominal cavity, and for the direct imaging of the pathological lesions. With EN being delivered before the open, elective operations, we get an amelioration of serum albumin values, and we have no morbidity related to the LJ or open, curative operation. EN was administrated after open surgery in the same way, and in the first case, during chemotherapy. LJ is an efficient, miniinvasive way for EN, in selected surgical severe malnourished patients with proximal digestive obstructions, especially oncologic ones, the aim being an amelioration of the nutritional status and a reduction of postoperative morbidity. A continuous study on a larger number of cases is imperative necessary.