Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka, 589-8511, Japan.
Surg Endosc. 2020 Nov;34(11):4967-4974. doi: 10.1007/s00464-019-07289-6. Epub 2019 Dec 9.
Feeding jejunostomy (FJ) is a common treatment to support patients with esophageal cancer after esophagectomy. However, severe FJ-related complications, such as bowel obstruction, occasionally occur. We investigated the ability of our simple, novel FJ technique, the "curtain method," to prevent bowel obstruction.
In laparoscopic surgery, the main mechanism of bowel obstruction involves torsion of the mesentery accompanied by migration of the intestine across the fixed FJ through the space surrounded by a triangle comprising the ligament of Treitz, fixed FJ, and spleen rather than adhesion. Our "curtain method" involves closure of this triangle zone with omentum, and the appearance of the lifted omentum resembles a curtain. Sixty patients treated with this modified FJ were retrospectively compared with 13 patients treated with conventional FJ in terms of the incidence of bowel obstruction, peritonitis, stoma site infection, and catheter obstruction.
From 2013 to 2017, 60 patients underwent esophagectomy and gastric conduit reconstruction accompanied by modified laparoscopic FJ. The median observation period, including the period after tube removal, was 644 days. No FJ-associated bowel obstruction, the prevention of which was the primary aim, occurred in any patient. Likewise, no peritonitis or dislodgement occurred. Eight patients (13%) developed a stoma site infection with granulation. The feeding tube became occluded in 11 patients (18%); however, a new feeding tube was reinserted under fluoroscopy for all of these patients. From 2003 to 2012, 13 patients underwent conventional FJ. The median observation period was 387 days. Three patients (23%) developed bowel obstruction by torsion 71 to 134 days after the first surgery, and all were treated by emergency operations. Other FJ-related complications were not different from those in the modified FJ group.
Our simple, novel technique, the "curtain method," for prevention of laparoscopic FJ-associated bowel obstruction after esophagectomy is a safe additional surgery.
空肠造口术（FJ）是食管癌手术后支持患者的常见治疗方法。然而，严重的 FJ 相关并发症，如肠梗阻，偶尔会发生。我们研究了我们简单新颖的 FJ 技术，即“幕帘法”，预防肠梗阻的能力。
在腹腔镜手术中，肠梗阻的主要机制涉及肠系膜扭转，伴有肠穿过由Treitz 韧带、固定 FJ 和脾脏围成的三角形空间的固定 FJ，而不是粘连。我们的“幕帘法”涉及用网膜封闭这个三角区域，提起的网膜看起来像一个幕帘。60 例接受改良 FJ 治疗的患者与 13 例接受常规 FJ 治疗的患者在肠梗阻、腹膜炎、造口部位感染和导管阻塞的发生率方面进行了回顾性比较。
2013 年至 2017 年，60 例患者接受了食管癌和胃管重建手术，并伴有改良腹腔镜 FJ。包括拔管后在内的中位观察期为 644 天。没有发生任何与 FJ 相关的肠梗阻，这是主要的预防目标。同样，没有发生腹膜炎或移位。8 例（13%）患者出现造口部位感染和肉芽形成。11 例（18%）患者的喂养管发生阻塞；然而，所有这些患者都在透视下重新插入了新的喂养管。2003 年至 2012 年，13 例患者接受了常规 FJ。中位观察期为 387 天。3 例（23%）患者在首次手术后 71 至 134 天发生肠扭转性肠梗阻，均需紧急手术治疗。其他与 FJ 相关的并发症与改良 FJ 组无差异。
我们简单新颖的预防食管癌手术后腹腔镜 FJ 相关肠梗阻的“幕帘法”是一种安全的附加手术。
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