Feeding Jejunostomy Tube Research Articles

Pre-therapy Laparoscopic Jejunostomy Provides Safe, Reliable Nutrition for Trimodality GEJ Cancer Care

Background: Patients with locally advanced GEJ cancer may have severe obstruction and irreversible malnutrition requiring intervention such as TPN, stenting, or enteral access. Laparoscopic jejunostomy (LJ) is a reliable method of supplementing nutrition but is not widely used for fear of complications. At our institution we place LJ tubes preoperatively in such patients and aimed to evaluate their effectiveness. Methods: A retrospective review of patients undergoing neoadjuvant chemo-radiation and laparoscopic transhiatal esophagectomy (LTHE) from 2013 to 2022 was performed. Nutritional markers, weight, and height were recorded, LJ associated complications were recorded from placement time to removal. Thirty-day complications after LTHE were recorded using Clavien-Dindo classification. Results: Of 165 patients who underwent LTHE, twenty patients (12.1%) had LJ placement prior to neoadjuvant therapy due to obstructive symptoms and a median [IQR] weight loss of 13.6 kg [9.07, 16.74] despite dietary modification. LJs were placed a median [IQR] of 103.5 [93.3, 116.8] days prior to LTHE. Median [IQR] weight gain from LJ placement to LTHE was 2.09 kg [0.1, 5.03], P = .01. There were no major complications and 3 (15%) minor complications. There were no unplanned feeding interruptions greater than 48 hours or disruptions in neoadjuvant treatment. There was 1 (5%) 30-day complication after LTHE and there was no mortality. The median [IQR] hospital stay was 7 days [6.5, 9]. Conclusion: Jejunostomy feeding tube prior to neoadjuvant treatment consistently reverses weight loss with minor, manageable complications. Reliable pre-therapy nutrition in obstructed patients is associated with excellent esophagectomy results and should be considered the adjuvant nutritional treatment of choice.

Incidence and Management of Pharyngo Cutaneous Fistula Following Total Laryngectomy - A Single Institutional 10 Years Experience.

Pharyngocutaneous fistula (PCF) is a common postoperative complication in patients undergoing laryngectomy. Many studies have focused on the predisposing factors and their treatment, but there is still controversy on how to identify high-risk patients.PCF is associated with delay in adjuvant treatment, prolonged hospital stay, and the requirement for additional surgical procedures. The increased incidence of post-laryngectomy PCF in the modern era of organ preservation therapy has driven considerable efforts to develop techniques to avoid and treat this complication. The study aims to analyze the incidence, predisposing factors, management, and outcome of PCF in post laryngectomy patients. We reviewed retrospectively the medical records of 72 patients who underwent total laryngectomy during the period from 2013 to 2022 at our institute. Details regarding age, gender, tumor site, comorbidities, radiotherapy, chemotherapy, duration of nasogastric tube feeding, the incidence of PCF and its management, and length of hospital stay. In our analysis of 72 patients, with 38 undergoing upfront laryngectomy and 34 salvage laryngectomy post-chemoradiation, we observed a 23% incidence of Pharyngocutaneous Fistula (PCF). Our univariate analysis revealed that low pre-op albumin levels and advanced stage significantly increased the risk of PCF. Specifically, PCF occurred in 16% of upfront laryngectomy patients and increased to 32% in salvage laryngectomy patients, though there was no significant association with pre-operative radiotherapy (RT).Among PCF cases, those from upfront laryngectomy had a mean onset time of 12 days, while salvage laryngectomy cases had a mean onset time of 8 days. The majority of PCF cases (64%) were managed conservatively, with 11% resolving through secondary suturing and 25% requiring surgical repair using local flaps. Notably, 80% of upfront laryngectomy PCF cases were managed conservatively, compared to 54% in salvage laryngectomy cases.The average hospitalization time for PCF patients was significantly longer at 35.6 days, compared to 12 days for non-PCF patients. Importantly, there were no fatal complications related to PCF in either group. Our study found that Pharyngocutaneous Fistula (PCF) occurs in both irradiated and non-irradiated patients, with T staging and pre-op albumin levels being significant risk factors. While PCF in non-irradiated patients can be treated conservatively, those in chemoradiation patients often require surgical intervention. Postoperative nutritional support like Feeding jejunostomy or Peg tube insertion aids in patient recovery from PCF.

Feeding Jejunostomy in Pancreatico-Duodenectomy patients: Is it important

BackgroundDuring a pancreaticoduodenectomy, Feeding Jejunostomy (FJ) is frequently placed to improve postoperative nutrition. Our aim is to ascertain the effects of the FJ tube after pancreaticoduodenectomy. MethodsProspective analysis was performed on all patients who underwent concurrent FJ after pancreaticoduodenectomy (Whipples surgery) between 2022 and 2023. On POD 1, FJ feeds were frequently initiated. After the patient had taken enough oral feeds, the jejunostomy feeds were stopped. Frequency and mean were used to represent the data. ResultsA total of 48 patients underwent pancreaticoduodenectomy with concomitant FJ. A total of 35 (72.9%) were men and the mean age was 49.2 years. The majority (28, 58.3 %) of these patients had cancer head of the pancreas as an indication for surgery. Only 13 out of 48 (27%) patients required nutrition supplementation through FJ on POD 10. Only 1 out of 48 (2%) patients required FJ feeds on POD 30. None of these patients had tube-related complications in the 30-day postoperative period. There was a single FJ-related mortality in the 30-day postoperative period due to pulmonary embolism. The patients, who required prolonged FJ feeds had grade C pancreatic leaks, delayed gastric emptying, and surgical site infection. ConclusionThe routine use of concurrent FJ in patients undergoing pancreaticoduodenectomy has a good outcome, especially for those who require prolonged postoperative nutritional supplementation because of grade c pancreatic leak and delayed gastric emptying.

Management of Postgastric Bypass Jejuno-jejunal Anastomotic Leak: A Multicenter Retrospective Study

Abstract Introduction: Anastomotic leakage is one of the most critical complications following gastric bypass surgery. Leakage from jejuno-jejunal (JJ) anastomosis after Roux-en-Y gastric bypass occurs infrequently, and so there are fewer studies on its management. The JJ anastomotic leak (AL) has high morbidity and mortality; hence, early detection and timely management are critical to optimizing outcomes. Aims and Objectives: We evaluated all the treatment options for the patients experiencing JJ anastomosis leaks to propose an algorithm-based practical management guideline for these patients. Materials and Methods: During the early postoperative period, retrospective analysis using clinical findings, blood parameters, and contrast computed tomography scans were carried out, and patients were classified into various categories such as leak with/without septicemia and leak with or without extravasation of contrast. All the patients were managed differently based on the category they belonged to. Results: Over a period of 3 years, out of 1393 cases of gastric bypass, 11 patients (0.78%) were diagnosed with postoperative JJ AL within 6 weeks of the postoperative period. The earlier cases were extensively treated with diagnostic laparoscopy along with local lavage, insertion of a feeding jejunostomy tube, leakage site drainage, proximal drainage, and nasogastric decompression with or without intensive care, causing considerable hospital stay and increased morbidity. With experience, we realized that all patients with leaks do not require extensive management. We have eventually determined an algorithm to manage JJ ALs depending on clinical and radiological parameters. Conclusion: Our individualized and effective algorithm-based management protocol results in quicker recovery, optimizes the intervention, and minimizes hospital stay, morbidity, and mortality after postoperative JJ AL. It can potentially mitigate the cost burden in India while ensuring a better outcome. This retrospective pilot study can be a practical guideline for the optimal management of JJ ALs after gastric bypass.

Effectiveness of long-term tube feeding intervention in preventing skeletal muscle loss after minimally invasive esophagectomy.

Esophageal cancer is a lethal tumor typically treated by neoadjuvant chemotherapy and surgery. For patients undergoing esophagectomy, postoperative enteral nutrition is important in preventing complications. Sarcopenia is associated with poor postoperative outcomes in esophageal cancer. In this study, we evaluated the benefits of tube feeding intervention and compared its short- and long-term outcomes in patients who underwent esophagectomy. Propensity score matching was performed in 303 patients who underwent esophagectomy at Kobe University Hospital between 2010 and 2020. Patients were divided into feeding and nonfeeding jejunostomy tube groups (n = 70 each). The feeding jejunostomy tube group was further divided into long-term (≥ 60days) and short-term (< 60days) subgroups. The groups were then retrospectively compared regarding postoperative albumin levels, body weight, and psoas muscle area and volume. In the long-term feeding jejunostomy tube group, anastomotic leakage (p = 0.013) and left laryngeal nerve palsy (p = 0.004) occurred frequently. There were no significant between-group differences in postoperative albumin levels, body weight, or psoas muscle area. However, significant psoas muscle volume recovery was confirmed in the long-term jejunostomy tube group at 6months postoperatively (p = 0.041). Tube feeding intervention after minimally invasive esophagectomy may attenuate skeletal muscle mass loss and help prevent sarcopenia.

Very Rare Complication of Percutaneous Endoscopic Jejunostomy Feeding Tubes in Patients with Intestinal Dysmotility

Very Rare Complication of Percutaneous Endoscopic Jejunostomy Feeding Tubes in Patients with Intestinal Dysmotility

The impact of jejunostomy feeding on nutritional outcomes after oesophagectomy.

Nutritional status is compromised long-term following oesophagectomy. Controversy surrounds the optimal route for nutrition support postoperatively and there is wide variation in the use of feeding jejunostomy tubes. A retrospective service evaluation was conducted for all consecutive adults who underwent oesophagectomy for a cancer diagnosis within a specialist centre between April 2016 and July 2019 (n = 165). Nutritional and clinical outcomes were compared for patients who received jejunostomy feeding (n = 24), versus those who did not (n = 141). Patients with feeding jejunostomy lost significantly less weight at both 6 and 12 months postoperatively compared to those without jejunostomy (p ≤ 0.001 and p = 0.001, respectively). This remained statistically significant in multiple regression, controlling for age, gender, preoperative tumour staging and adjuvant treatment (p ≤ 0.001 and p = 0.03, respectively). Median length of home enteral feeding was 10 weeks after discharge in the jejunostomy group. We observed minor jejunostomy tube-related complications in four patients (16.7%). Of those readmitted within 90 days of surgery in the non-jejunostomy group, nutritional failure was a factor in 43.2% of these readmissions. "Rescue tube feeding" was required by 8.5% of the non-jejunostomy group within the first postoperative year, including 6.4% within 90 days of surgery. Use of short-term supplementary jejunal feeding in addition to oral intake after hospital discharge is beneficial for maintaining weight after oesophagectomy. We suggest a future randomised-controlled trial to confirm these findings.

Development of a gastrocutaneous fistula from a marginal ulcer after repair of duodenal injury with pyloric exclusion

Duodenal trauma is rare but can be associated with significant morbidity and mortality (Pandey et al., 2011) [1]. Adjunct procedures, such as pyloric exclusion, can be performed to assist in surgical repair of these injuries. However, pyloric exclusion can lead to severe long-term complications associated with significant morbidity that can be difficult to repair. A 35-year-old man with a history of duodenal trauma from a gunshot wound (GSW) status post pyloric exclusion and Roux-en-Y gastrojejunostomy presented to the Emergency Department (ED) with complaints of abdominal pain and leakage of food particles and fluid from an open wound around his surgical scar. Computed tomography (CT) scan on admission showed a tract extending from the gastrojejunostomy anastomosis to the skin representing a fistula. Esophago-gastro-duodenoscopy (EGD) reconfirmed a large marginal ulcer that had fistulized to the skin. After nutritional repletion, the patient was taken to the operating room (OR) for takedown of the enterocutaneous fistula and Roux-en-Y gastrojejunostomy, closure of gastrostomy and enterotomy, pyloroplasty and feeding jejunostomy tube placement. The patient was re-admitted after discharge with abdominal pain, vomiting and early satiety. EGD showed gastric outlet obstruction and severe pyloric stenosis which was managed with endoscopic balloon dilation. This case represents the severe and potentially life-threatening complications that may occur after pyloric exclusion with Roux-en-Y gastrojejunostomy. Gastrojejunostomies are prone to marginal ulceration which can perforate if not adequately treated. Free perforations cause peritonitis, but if the perforation is contained it can erode through the abdominal wall creating the rare complication of a gastrocutaneous fistula. Even after restoration of normal anatomy with a pyloroplasty, patients may suffer additional complications such as pyloric stenosis requiring continued intervention.

Feeding Jejunostomy Tube in Patients Undergoing Esophagectomy: Utilization and Outcomes in a Nationwide Cohort.

Feeding jejunostomy (JT) tubes are often utilized as an adjunct to optimize nutrition for successful esophagectomy; however, their utility has come into question. The aim of this study was to evaluate utilization and outcomes associated with JTs in a nationwide cohort of patients undergoing esophagectomy. The NSQIP database was queried for patients who underwent elective esophagectomy. JT utilization was assessed between 2010 and 2019. Post-operative outcomes were compared between those with and without a JT on patients with esophagectomy-specific outcomes (2016-2019), with results validated using a propensity score-matched (PSM) analysis based on key clinicopathologic factors, including tumor stage. Of the 10,117 patients who underwent elective esophagectomy over the past decade, 53.0% had a JT placed concurrently and 47.0% did not. Utilization of JTs decreased over time, accounting for 60.0% of cases in 2010 compared to 41.7% in 2019 (m = - 2.14 95%CI: [- 1.49]-[- 2.80], p < 0.01). Patients who underwent JT had more composite wound complications (17.0% vs. 14.1%, p = 0.02) and a higher rate of all-cause morbidity (40.4% vs. 35.5%, p = 0.01). Following PSM, 1007 pairs were identified. Analysis of perioperative outcomes demonstrated a higher rate of superficial skin infections (6.1% vs. 3.5%, p = 0.01) in the JT group. However, length of stay, reoperation, readmission, anastomotic leak, composite wound complications, all-cause morbidity, and mortality rates were similar between groups. Among patients undergoing elective esophagectomy, feeding jejunostomy tubes were utilized less frequently over the past decade. Similar perioperative outcomes among matched patients support the safety of esophagectomy without an adjunct feeding jejunostomy tube.

Cost–effectiveness analysis of jejunostomy tube feeding versus conventional nutritional method in esophageal cancer: a retrospective case control study

Cost–effectiveness analysis of jejunostomy tube feeding versus conventional nutritional method in esophageal cancer: a retrospective case control study

Severe Intentional Corrosive (Nitric Acid) Acute Poisoning: A Case Report and Literature Review.

Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances.

The role of feeding jejunostomy on supportive enteral nutrition for resectable esofago-gastric junction adeno carcinoma undergoing total gastrectomy and esofago jejunostomy reconstruction: a case series

As a part of enhanced recovery after surgery protocols (ERAS), early gut feeding has been applicated in most of gastrointestinal surgery including major resection of distal esophageal and esofago-gastric junction adeno carcinoma. Early gut feeding could be applicated not only in minimally invasive procedure, but also in conventional open technique. Many enteral feeding option can be chosen as a post-operative enteral nutrition for the patients. One of them is feeding jejunostomy tube placement, we will evaluate the safety and effectivity of this enteral route on resectable esofago-gastric cancer resection. We will evaluate the clinical outcome of resectable esofago-gastric cancer patients and reconstruction, feeding jejunostomy tube has been placed as post-operative enteral route for nutrition. The patient with history of neoadjuvant therapy will be excluded. The post-operative evaluation including morbidity associated with jejunostomy tube will be recorded. We reported 4 cases, all of them had stage III esofago-gastric adeno carcinoma and conventional laparotomy technique was done. Feeding jejunostomy was tolerated well by the patients, enteral feeding can be started during the first 24 hours after surgery. No post-operative ileus and surgical site infection has been reported. Tube site infection was not found during this study. Although it still remains controversial, feeding jejunostomy tube was safe, feasible and has been tolerated well on esofago-gastric cancer patients undergoing resection and reconstruction.

Tutorial on adult enteral tube feeding: Indications, placement, removal, complications, and ethics.

Enteral nutrition, generally preferred to parenteral nutrition, is indicated when patients cannot meet their energy and metabolic demands. Gastrostomy tubes are placed directly into the stomach (either endoscopically, surgically, or radiologically) through the abdominal wall. Routine gastrostomy tube care is important to maintain well-functioning tubes. Postpyloric feeding tubes are preferable to gastric feeding tubes if patients have a history of aspiration, gastroesophageal reflux, severe gastroparesis, and/or recurrent nausea and vomiting. Feeding jejunostomy tubes are placed surgically and are indicated if gastric feeding is unsafe or impossible. Dual-lumen gastrojejunostomy tubes are used when both gastric decompression and feeding are desired. The general risks of enteral tube feeding include diarrhea, metabolic derangements, and aspiration. Additional complications for gastrostomy tubes, which can arise at any time, include tube dysfunction (clogging or deterioration), infection, bleeding, peristomal leakage, ulceration, gastric outlet obstruction, and accidental removal. After percutaneous endoscopic gastrostomy placement, there are also early or late complications that may occur. Multiple factors should be considered in the decision-making process for feeding tube placement. It is important to be realistic about the patient's prognosis and goals and to discuss the risks and benefits ahead of time. Consultation with palliative care or clinical ethics specialists should be considered in certain clinical scenarios.

Comparisons of nutritional status and complications between patients with and without postoperative feeding jejunostomy tube in gastric cancer: a retrospective study.

Feeding jejunostomy tube (FJT) enables early postoperative nutritional supply for gastric cancer patients undergoing surgery. However, the nutritional benefit of FJT may be accompanied by potential risk of increased complications, so both the nutritional improvement and the complication rates associated with FJT should be assessed. From January 2009 to December 2014, 715 consecutive patients underwent gastric cancer resection at the Peking Union Medical College Hospital in China. The perioperative nutritional index and incidence of complications in patients with FJT placement were retrospectively compared to those in patients without FJT placement. Nutritional data including albumin, prealbumin, hemoglobin, and high sensitivity C-reactive protein, the neutrophil-to-lymphocyte ratio (NLR), and Onodera's prognostic nutrition index (OPNI) were recorded at the following 3 timepoints: preoperatively, 1-week postoperatively, and 1-month postoperatively. Postoperative complications including surgical site infection, intra-abdominal infections, anastomotic leaks and gastroparesis were assessed. Multivariate logistic regression was used to study the association between FJT and complications. A total of 715 patients were included in the study. The mean age was 60.4 years and 72.2% were male. The overall characteristics between FJT and no-FJT groups were comparable. Of the 247 total gastrectomy cases, 98 (39.7%) had a FJT placed. Compared to the total gastrectomy patients without a FJT, the 98 patients with a FJT had a lower hemoglobin level (P=0.048) and NLR (P=0.030) preoperatively, and higher albumin (P=0.005), prealbumin (P<0.001), and hemoglobin (P=0.014) levels, a higher OPNI (P=0.027), and a lower NLR (P=0.005) 1-month postoperatively. Of the 468 subtotal gastrectomy cases, 87 (18.6%) had a FJT placed. Compared to the subtotal gastrectomy patients without a FJT, these 87 patients had a lower NLR (P=0.006) 1-week postoperatively, and a higher albumin level (P=0.009) 1-month postoperatively. In the multivariate analysis, FJT placement was not associated with postoperative adverse outcomes, including surgical site infection [odds ratio (OR) =1.21, P=0.79], intra-abdominal infection (OR =0.38, P=0.11), anastomotic leak (OR =0.58, P=0.53), reoperation (OR =0.22, P=0.23), gastroparesis (OR =6.35, P=0.08), or hospitalization for more than 30 days (OR =0.58, P=0.32). Early enteral nutritional support by FJT after gastrectomy tended to improve the nutritional status of patients, while it did not appear to increase the incidence rate of postoperative complications.

A rare case of recurrent hyperparathyroidism

Abstract A 58 year old man presented to our hospital three years ago with history of upper abdominal pain, recurrent vomiting and dehydration. On evaluation, pancreatitis with mass in the head of pancreas was diagnosed. Fine needle aspiration from pancreatic head mass was suggestive of low-grade adenocarcinoma. Whipple's procedure was planned and the surgical gastroenterology team did open pylorus resecting pancreatoduodenectomy and feeding jejunostomy for him in October 2016. But the biopsy was reported as chronic calcific pancreatitis. On workup, hypercalcemia (12.5 mg/dl) was noted and hyperparathyroidism due to right inferior parathyroid adenoma was diagnosed as PTH levels were elevated (iPTH-474 pg/ml). He had a slippage of the jejunostomy tube and was readmitted. Right inferior parathyroidectomy was done by the surgical oncologist along with the repair of slipped feeding jejunostomy tube by the surgical gastroenterology team in the same sitting in March 2017. Biopsy was reported as right inferior parathyroid adenoma. Post-surgery, he had hungry bone syndrome which stabilized after one month. After 6 months, he started noticing a small nodule in the right side of the neck which progressively increased in size from a small nodule to a size of 1*1 cm over a duration of one year, associated with multiple small nodules superiorly. He also complained of weight loss, constipation, generalized weakness, and bone pains. Hypercalcemia was noted and iPTH level was again elevated (564.7 pg/ml). He was admitted for evaluation for recurrence of parathyroid adenoma/ parathyroid carcinoma/ parathyromatosis. Ultrasonography of the neck showed a 4*3 mm hypoechoic lesion with internal vascularity noted posterior to right lobe of thyroid and medial to great vessels, and multiple heterogenous hypoechoic well-defined lesions noted in the subcutaneous plane on the right side of the neck, few noted along surface of right strap muscle and sternocleidomastoid muscle. FNAC of the subcutaneous nodule was suggestive of parathyroid adenoma. Parathyroid scan showed multiple MIBI-avid nodule seen anterior and lateral to inferior pole of thyroid gland. He was operated in February 2019 and five nodules were removed. Biopsy was suggestive of parathyroid carcinoma. After the surgery, his symptoms improved but Calcium(13mg/dl) and iPTH (453 pg/ml) levels were elevated at 3 months follow up. Biopsy was suggestive of parathyroid carcinoma. But in view of the previous surgery, earlier biopsy report of adenoma and no metastasis, he was diagnosed to have parathyromatosis. A follow up CT revealed residual nodules in the neck. A repeat surgery was done in August 2019 to remove the nodules as the patient complained of persistent generalized malaise and bone pains. Following surgery, his iPTH levels remained elevated (iPTH pre-op-492.4 pg/ml; post-op- 444.4 pg/ml). His symptoms improved mildly. He was started on medical management for hypercalcemia with Cinacalcet. Figure 1. Image of the neck of the patient showing multiple nodules.

Laparoscopic feeding jejunostomy using T-tube-technique and analysis of outcomes

Background: Enteral nutrition is of paramount importance in management of upper gastrointestinal tract malignancies. Although various access routes for enteral nutrition are available, feeding jejunostomy tube is preferred to other methods. Since minimally invasive techniques have many advantages, we decided to perform it during staging laparoscopy.Methods: The medical records of all patients who underwent laparoscopic feeding jejunostomy between October 2019 and September 2021, in the department of surgical gastroenterology, Madurai medical college were retrospectively reviewed. Patient demographics, ECOG performance status, types of malignancy, indications for feeding jejunostomy, operative time, time to start feeds, length of hospital stay and complications were analysed.Results: 75 patients underwent laparoscopic feeding jejunostomies (51 men and 24 women), with a mean age of 51.6±11.7 years, using this method. ECOG performance status was between 0-2. Mean operating time was 83±8.8 minutes. Mean length of hospital stay was 3.5 days. There was no conversion, however one patient required reoperation for peritubal leak.Conclusions: Feeding jejunostomy can be accomplished by a total laparoscopic technique using intracorporeal suturing. The technique we propose is relatively simple, reproducible, cost effective and can be widely adopted.

Outcomes of feeding jejunostomy after pancreaticoduodenectomy: A single-center experience.

Feeding jejunostomy tube (FJT) is one option for enteral nutrition after pancreaticoduodenectomy (PD); however, controversy regarding its clinical outcome(s) persists. The aim of the present study was to determine the safety and efficacy of FJT management. Data from 156 consecutive patients, who underwent PD between January 2015 and December 2017, were retrospectively reviewed. Safety was assessed according to postoperative and tube-related complications. Nutritional efficacy was evaluated based on improvement in serum albumin levels. Thirty-day morbidity and mortality rates were 61.0% (n = 95) and 1.9% (n = 3), respectively. The rates of clinically relevant postoperative pancreatic fistula and delayed gastric emptying were 30.8% and 9.0%, respectively. In total, nine (5.8%) patients experienced complications directly related to FJT. Eight patients experienced surgical site infection adjacent to the catheter/skin interface. Although all required catheter removal at the bedside or in the office, none required reoperation. The improvement in serum albumin level 1 month after PD was 40.7% compared with 1 week after PD. FJT was useful in improving nutritional intake and status. Although FJT was associated with minor self-limiting complications, they could be managed by simple bedside or office treatment. As such, results of this study support the safety and efficacy of the FJT protocol used in the authors' department for nutritional management.

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# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Barriers and Facilitators in Implementation of a New Postoperative Esophagectomy Care Pathway: A Qualitative Analysis

INTRODUCTION: We recently implemented a new esophagectomy pathway that included significant practice changes, including gastric ischemic preconditioning 4 weeks before definitive surgery and routine placement of feeding jejunostomy tubes. Practice pattern changes can prove challenging. We therefore sought to determine barriers and facilitators to the implementation at the provider level. METHODS: We utilized qualitative method guided by the Theoretical Domains Framework to study the adoption and implementation of a post-esophagectomy care pathway. Sixteen interviews with providers involved with the pathway were conducted and analyzed using Matrix Analysis. RESULTS: Salient Theoretical Domains Framework domains identified included: knowledge, beliefs about consequences, and environmental context and resources. Facilitators included electronic health record tools (note templates including pathway components, pathway specific order set), patient satisfaction, and preliminary data suggesting reduced anastomotic leak rate. Barriers reported included hesitance to abandon previous practices and a desire for more concrete data prior to changing practice; these were most prevalent at the faculty level. Suggestions included improving post-discharge communication between providers and access to pathway documents by the clinical team. CONCLUSION: The Theoretical Domains Framework was successfully able to identify individuals’ perceived barriers and facilitators to implementation and adoption of an esophagectomy pathway that included significant practice changes. This analysis helped inform faculty about implementation and promoted communication between providers about pathway components. The findings of this qualitative methodology may inform future surgical patient care protocol implementations.

224. PURSUING ERAS POST-OESOPHAGECTOMY WITHOUT ENTERIC FEEDING TUBES: A 12 YEAR SINGLE CENTRE EXPERIENCE

Abstract Early feeding post oesophagectomy is encouraged. Surgical outcomes from different routes of feeding be it oral, via nasoenteral or jejunostomy tubes remains debatable due to ERAS protocol variations. We present our outcomes from our single regional centre where oesophagectomies are completed without the insertion of nasoenteric or feeding jejunostomy tubes, and therefore oral intake being the sole route of post-operative nutrition. A retrospective study employed an electronic database of elective Ivor Lewis oesophagectomies from April 2009 to December 2021 at a tertiary upper gastrointestinal cancer centre in the United Kingdom. All patients without nasoenteric or jejunostomy tubes were included in the study, as this is the routine practice. Our practice involves a gradual increase in oral fluids from day 0 to 4, with supplementary intravenous fluid. We introduce a soft diet from the 5th post-operative day. We evaluated patient outcomes using the Clavien-Dindo grade (CDG). Primary outcomes were anastomotic leaks, length of stay, chyle leaks, and 30- and 90-day mortality. 578 Ivor Lewis oesophagectomies were peformed between 2009–2021 without any jejunostomies or nasoenteric tubes inserted. The median age was 63 years old (45–82) with M:F 1.8:1. The median length of stay (LOS) was 13 (3–148) days. Chyle leak was identified in 24 patients (4.2%) and of these 83.3% (n = 20) underwent surgical management with a mortality of 5% (n = 1). 16.7% (n = 4) chyle leaks were managed conservatively with a median LOS of 31 days (14–51), with no mortality. Anastomotic leaks were identified in 26 cases (4.5%), outcomes illustrated in the table. The 30- &amp; 90-day mortality was 0.3% (n = 2) and 0.9% (n = 5). While the best route of feeding post oesophagectomy remains contentious and variable, we have shown that surgical outcomes from performing oesophagectomies without the insertion of any enteric feeding tubes is feasible and safe. While this challenges conventional paradigm, we demonstrate early oral intake using a well-defined ERAS protocol poses no increased risk of surgical complications and negates the additional risks inherent from jejunal tubes and artificial feeding.