Feeding catheter gastrostomy with the round ligament of the liver prevents mechanical bowel obstruction after esophagectomy

• Published in: Diseases of the esophagus Vol. 30; no. 6; pp. 1 - 8
• Main Authors: Kawai, R., Abe, T., Uemura, N., Fukaya, M., Saito, T., Komori, K., Yokoyama, Y., Nagino, M., Shinoda, M., Shimizu, Y.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-06-2017
• Subjects: Aged; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Esophagectomy - methods; Female; Gastrostomy - methods; Humans; Incidence; Intestinal Obstruction - epidemiology; Intestinal Obstruction - etiology; Intestinal Obstruction - prevention & control; Jejunostomy - methods; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Round Ligament of Liver - surgery; bowel obstruction; esophagectomy; feeding catheter gastrostomy
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/dox009

SUMMARY
Jejunostomy, which requires the fixation of the jejunum to the abdominal wall, is commonly used as an enteral feeding access after esophagectomy. However, this procedure sometimes causes severe complications, such as mechanical bowel obstruction. In 2009, we developed a modified approach to insert an enteral feeding tube through the reconstructed gastric tube using the round ligament of the liver. The aim of this study is to investigate the usefulness of this approach as compared to the approach through jejunostomy. Between January 2005 and March 2015, 420 patients with thoracic esophageal cancer underwent esophagectomy via thoracotomy and laparotomy. Of these, 214 underwent feeding jejunostomy (FJ group) and 206 patients underwent feeding via gastric tube with round ligament of the liver (FG group). Catheter-related complications, other postoperative complications, and mortality were compared between the two groups. The incidence of catheter site infection during catheterization in the FG group was significantly lower (n = 1/206, 0.5%) compared to the FJ group (n = 11/214, 5.1%) (P < 0.01). The postoperative bowel obstruction did not occur in the FG group, while it occurred in eight patients (3.7%) in the FJ group (P < 0.01). The incidences of other catheter-related and postoperative complications were similar between the two groups. Feeding catheter gastrostomy with the round ligament of the liver can be a useful enteral feeding access after esophagectomy, because the incidence rate of severe catheter-related complications, such as surgical site infection and mechanical obstruction tend to be lower with this technique compare to jejunostomy.