SP6.1.1 The Safety of Laparoscopic Feeding Jejunostomy Insertion in Patients with Oesophago-gastric Pathology

Abstract

Abstract Aims Feeding jejunostomy (FJ) to support enteral nutrition has traditionally been placed using an open approach (OA). As minimally invasive surgery (MIS) for oesophageal and gastric surgery gains popularity, it is imperative to develop a standardised technique and examine its safety. We describe our MIS approach to FJ insertion and compare outcomes to OA. Methods This was a retrospective analysis of patients undergoing FJ insertion via MIS and OA in a high volume tertiary oesophago-gastric centre, from 2018 to 2020. Identifying and placing FJ in first jejunal loop at low pneumoperitoneum pressure, constructing Witzel tunnel and placing antitorque sutures are our institution's standardised steps. Outcomes assessed included catheter-related adverse events. Results Of 226 patients, 130 (57.5%) had MIS, while 96 (42.5%) had OA. Median age (63.0 vs. 66.0 years, p=0.04), BMI (26.1 vs. 26.2 kg/m2, p=0.30), Charleston comorbidity index (4.0 vs. 4.0, p=0.73) and gender (75.4% vs. 76.0% males, p=1.00) were comparable. Median days FJ remained in situ was 162, 85.0% were placed in patients undergoing cancer resection, while MIC tube was used in 80.5%. A higher peri-catheter infection was seen with MIS (p=0.01); however, no differences (p≥0.42) were observed between MIS vs. OA, in tube dislodgement (9.0vs.6.0), fracture (2.0vs.2.0), blockage (2.0vs.0.0), peri-catheter leakage (6.0vs4.0), bowel obstruction (5.0vs.2.0) and perforation (0.0vs1.0). No feed inspissation or enterocolitis was observed. Misplacing FJ beyond first jejunal loop caused volvulus, necessitating reintervention. Conclusion FJ insertion via MIS is safe, provided standardised steps are followed meticulously. Evaluating confounding factors for better understanding of MIS-associated peri-catheter infection is recommended.