Laparoscopic Roux-en-Y Feeding Jejunostomy: A New Minimally Invasive Surgical Procedure for Permanent Feeding Access in Children with Gastric Dysfunction

Abstract

Long-term feeding access in children with foregut dysfunction has traditionally been achieved by gastrostomy tube placement with or without fundoplication. Alternatives after failed procedures have included re-do fundoplication, transpyloric gastrojejunal tube placement, loop jejunostomy (open or laparoscopic), and open Roux-en-Y jejunostomy. We describe a new technique, laparoscopic Roux-en-Y feeding jejunostomy (LRFJ), which offers a minimally invasive option in providing long-term enteral access to these children. Five children, ages 10 months to 9 years (mean age, 3.4 years), weighing 8.8 to 15.2 kilograms (mean weight, 12.3 kg), underwent LRFJ. Four children had mental retardation/cerebral palsy. In 3 children, LRFJ was the only intra-abdominal procedure performed. No technical complications related to the procedure were observed. Mean operative time was 98 minutes in the children in which LRFJ was the only procedure performed. Enteral feeds were typically begun by postoperative day (POD) 5. Follow-up has ranged from 12 to 30 months (mean follow-up, 23 months). All 4 survivors remain on full jejunal feedings and are doing well. One child developed stomal stenosis requiring dilatation. In summary, LRFJ can be performed safely in children with gastric dysfunction, may be performed in conjunction with a variety of other laparoscopic procedures, and offers a new option for nutritional access in this challenging pediatric population.