Enteral Feeding Access Research Articles

Laparoscopic suturing technique for enteral access procedures.

We have developed a technique to precisely place transabdominal-wall sutures to anchor the desired viscera to the abdominal wall during laparoscopic enteral-feeding access procedures. The use of an intravenous catheter and wire snare to achieve this is described.

A simplified technique for percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) is the preferred method of establishing long-term enteral access for feeding. Many patients requiring PEG are elderly and at risk for complications. Expeditious placement of the gastrostomy tube will minimize complications, but distorted esophageal anatomy can significantly lengthen the procedure. Some endoscopists abandon conventional repeat gastroscopy in difficult cases to accelerate the procedure. The authors describe a reliable method for quick reinsertion of the endoscope which shortens time required for PEG, and may reduce complications.

Anti-reflux gastrointestinal surgery in the neurologically handicapped child

The frequent requirement for gastrointestinal feeding tubes in the mental-motor retarded (MMR) child has become a relative indication for concomitant anti-reflux surgery in many pediatric surgical centers. The need for the addition of this relatively morbid procedure to simple feeding tube placement remains controversial. To analyze the role of anti-reflux surgery in the MMR child, we reviewed our experience with enteral feeding access procedures and anti-reflux procedures. A total of 76 feeding access procedures (71 gastrostomies) and 98 anti-reflux procedures were performed. All patients were thoroughly evaluated for the presence of reflux preoperatively. The presence of asymptomatic reflux prior to feeding tube placement was not predictive of subsequent need for fundoplication. Only 3 of 71 patients with gastrostomies (4.2%) ultimately required fundoplication. Of 106 MMR children in this series, 48 had an anti-reflux operation with their feeding gastrostomy while 58 had a primary feeding tube alone, 2 of which were jejunostomies. Although 2 children in the gastrostomy group later required fundoplication for uncontrolled GER, the other 54 were managed without an anti-reflux procedure. Our experience does not support the routine performance of concomitant anti-reflux surgery with feeding tube placement in the MMR child and argues for a conservative approach to feeding access. Fundoplication should be reserved for those children with a clinical indication for an anti-reflux operation.

Management of Complex Perineal Soft-tissue Injuries

Debridement, fecal diversion, and rectal washout have been proposed as the primary therapy for complex perineal lacerations, but, in most series, survivors have a pelvic sepsis rate of 40-80%. In a retrospective study, six of 18 patients sustaining severe perineal lacerations died within the first few hours of injury due to exsanguination from pelvic injuries. The remaining 12 patients underwent sigmoidoscopy, diversion of the fecal stream with irrigation of the distal rectal stump, and radical initial debridement of necrotic soft tissue. Enteral access was obtained in two patients. In the patients with mandatory daily debridement and pulsatile irrigation, no pelvic sepsis occurred. In three patients without daily debridement, pelvic sepsis complicated recovery. The ability of patients to resume oral nutrition was significantly delayed, necessitating total parenteral nutrition in three patients. We conclude that sigmoidoscopy, total diversion of the fecal stream with irrigation of the distal rectal stump, enteral access for feeding, radical initial debridement of necrotic soft tissue, and mandatory daily debridement with pulsatile irrigation optimize recovery from this devastating injury.

Obstructed feeding jejunostomy tube: a new method of salvage.

The jejunostomy tube is an important means of access for enteral feeding in the surgical and medical patient. A common complication of this technique is tube occlusion. Once a mature tract has formed the tube can be removed and replaced, following by contrast radiologic documentation of its intraluminal position. With an immature tract, this option is not available. We report a safe, simple, and cost-effective method of unblocking a clogged jejunostomy using an arterial embolectomy catheter.