Department of Surgery, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphoom Sub-District, Muang District, Chiang Mai, 50200, Thailand.
BMC Surg. 2024 Oct 14;24(1):310. doi: 10.1186/s12893-024-02607-9.
Obstructive upper GI cancer commonly uses feeding jejunostomy as a standard procedure. Surgeons implemented laparoscopic feeding jejunostomy via minimally invasive surgery, employing a variety of techniques. This study assessed the perioperative results, safety, and costs associated with laparoscopic versus open jejunostomy surgeries. We used only Witzel's tunnel and standard laparoscopic instruments.
We collected data from all patients who underwent feeding jejunostomy between January 2016 and June 2018. We recorded pertinent data on baseline, surgical outcomes, postoperative results, complications, and costs. The study excluded patients with jejunostomy as a conversion or an addition.
We divided the 74 patients into 2 groups: 30 underwent laparoscopy and 44 underwent open surgery. The mean operational times were 89.67 and 91.64 min and showed no statistically significant difference (p = 0.678). The mean morphine dosage was significantly lower in the laparoscopic group (3.3 vs. 7.19, p = < 0.001). Laparoscopic surgery lowered the median time of feeding initiation, feeding accomplished, and postoperative stay, although none of these reached statistical significance. There were significantly higher surgical expenses in the laparoscopic group (16,410 vs. 11,685 Thai Baht) (p < 0.001); however, median overall expenditures did not significantly differ (105,147 vs. 116,198 Thai Baht) (p = 0.387). Laparoscopic versus open surgery had similar incidences of postoperative complications (20% vs. 25%, p = 0.846). The feeding tube catheter location was infection-free in all patients in our study.
Laparoscopic jejunostomy feeding was safe, and postoperative morphine consumption was lower. Increasing operational costs did not have a significant impact on overall expenditures. Witzel's tunnel may reduce jejunostomy site infections.
阻塞性上消化道癌症通常采用经饲管空肠造口术作为标准程序。外科医生通过微创手术实施腹腔镜饲管空肠造口术，采用了多种技术。本研究评估了腹腔镜与开腹空肠造口术的围手术期结果、安全性和成本。我们仅使用 Witzel 隧道和标准腹腔镜器械。
我们收集了 2016 年 1 月至 2018 年 6 月期间所有接受饲管空肠造口术的患者的数据。我们记录了基线、手术结果、术后结果、并发症和成本的相关数据。该研究排除了作为转换或附加手术的空肠造口术患者。
我们将 74 例患者分为两组：30 例行腹腔镜手术，44 例行开腹手术。手术时间的平均值分别为 89.67 分钟和 91.64 分钟，无统计学显著差异（p=0.678）。腹腔镜组的吗啡用量明显较低（3.3 毫克与 7.19 毫克，p<0.001）。虽然腹腔镜手术降低了开始喂养、完成喂养和术后住院的中位数时间，但均无统计学意义。腹腔镜组的手术费用明显较高（16410 泰铢与 11685 泰铢）（p<0.001）；然而，中位数总支出无显著差异（105147 泰铢与 116198 泰铢）（p=0.387）。腹腔镜与开腹手术的术后并发症发生率相似（20%与 25%，p=0.846）。我们研究中的所有患者的饲管导管位置均无感染。
腹腔镜空肠造口术喂养是安全的，术后吗啡消耗量较低。增加手术费用对总支出没有显著影响。Witzel 隧道可能会降低空肠造口部位的感染率。
