Sistema gastrointestinal y digestivo

Abstracto

Complications Associated with Enteral Nutrition Using Tube Jejunostomy after Esophageal Reconstruction

Abdelkader Boukerrouche

Introduction: Esophageal reconstruction is a major surgery using a digestive graft. The nutritional support impacts directly outcomes of patients. The enteral route is the preferred one for instituting postoperative nutrition. Most complications was related to the methods of tube-jejunostomy. The purpose of this retrospective study to examine the complications associated with EN using a Witzel-type tube-feeding jejunostomy for postoperative nutritional support in esophageal reconstructive surgery.

Patients and Methods: Between 1999 and 2014, 105 patients underwent esophageal reconstruction by colon interposition and gastric tube. The mean age was 25.52 ± 13.86 years and the male/female ratio was 6.10. A Witzel-type tube-feeding jejunostomy was performed. The jejunum was attached to the peritoneum over a length of 5-8 cm. The number of calories administered was increased gradually. The complications associated with tube-jejunostomy and enteral nutrition were noted.

Results: The tube-feeding jejunostomy was could be placed in all patients. The postoperative nutrition by tube-jejunostomy was begun at day 1 in 41 patients (39 %) and day 7 in 64 patients after surgery. EN was well tolerated by all patients. The complication associated with the tube-jejunostomy was skin erosion at the entry of tube. One patient was re-operated for obstruction. The dislogement and blockage of tube were produced respectively in 1 and 2 patients. Abdominal pain and/or diarrhea was experienced by five patient. The complication rates related to the enteral nutrients and to placement of tube jejunostomy, were 4.7% and 2.8%, respectively.

Conclusion: The attachment of the jejunal wall to the peritoneum at the place of entry of the catheter/tube is useful to prevent leakage and twisting of the jejunum and to reduce the severity of the complications related to catheter/tube jejunostomy feeding.