Alternative method for jejunostomy in Ivor-Lewis esophagectomy

BACKGROUND To supplement nutrition, jejunostomy has been widely adopted as an adjunct surgical procedure for Ivor-Lewis esophagectomy. Most Chinese surgeons have a preference for parenteral nutrition even though it has some disadvantages compared with jejunostomy. In this report, we describe a new approach that allows the quick insertion of a feeding tube in Ivor-Lewis esophagectomy. We retrospectively analyze cases that have applied this approach and compare the advantages and disadvantages of jejunostomy. METHODS Between January 2010 and December 2012, 131 patients underwent Ivor-Lewis esophagectomy in our hospital. These patients were divided into three groups: the total parenteral nutrition (PN) group, the jejunostomy (JT) group and the feeding tube (FT) group. The effect and safety of the procedure were compared. RESULTS It took approximately 20 minutes longer to perform jejunostomy compared to placing a feeding tube (P < 0.05). The nutrition cost of the JT group was higher than the FT group (P < 0.05). There was no significant difference between the FT and JT groups (P > 0.05) in the ratio of body weight loss seven days post-surgery. The anal exsufflation time of the FT group was similar to the JT group (P > 0.05). The incidence of intestinal adhesion and obstruction in the JT group was 26.3%, which is much higher than in the FT and PN groups (P < 0.05). CONCLUSION Placing the feeding tube after Ivor-Lewis esophagectomy can decrease operative damage and bring sufficient nutrition. We believe it can be an alternative to jejunostomy in Ivor-Lewis esophagectomy.