Article

Witzel catheter feeding jejunostomy: is it safe?

Clinic of General Surgery, Kaunas University of Medicine, Kaunas, Lithuania.
Digestive Surgery (impact factor: 1.22). 02/2007; 24(5):349-53. DOI:10.1159/000107715 pp.349-53
Source: PubMed

ABSTRACT Patients often suffer from malnutrition after digestive tract surgery. It leads to a longer recovery and a higher rate of postoperative complications. Early postoperative jejunostomy feeding is a way of tackling this problem. Opinions emerge that feeding via jejunostomy catheter is not the ideal method because of its complications. Our aim was to assess a complication rate of longitudinal Witzel catheter feeding jejunostomy and complications related to the onset of enteral feeding.
A retrospective analysis of case histories of 136 patients operated on for upper digestive tract diseases at our clinic between 1992 and 2004 with catheter feeding jejunostomy as an adjunct. We interviewed our patients by telephone about the jejunostomy-related complications during the 1st postoperative year.
We observed two feeding jejunostomy-related complications (1.5%). Complications related to the onset of enteral feeding were observed in 12 cases (26.7%). There was no mortality. No complication of catheter jejunostomy was observed during the 1st postoperative year.
A longitudinal Witzel catheter jejunostomy feeding is beneficial after surgery of the upper digestive tract. It is a rather safe procedure, which can be safely started on the day of operation.

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    Article: Benefits versus risks: a prospective audit. Feeding jejunostomy during esophagectomy.
    Vikas Gupta
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    ABSTRACT: The purpose of this prospectively collected database is to evaluate the safety, efficacy, and utility of postoperative jejunostomy feeding in terms of achieving nutritional goals and evaluating gastrointestinal and mechanical complications in patients undergoing esophagectomy. The study included 204 consecutive patients who underwent esophagectomy for various benign and malignant conditions. All patients underwent Witzel feeding jejunostomy at the time of laparotomy. Patients were followed prospectively to record nutritional intake, type of feed administered, rate progression, tolerance, and complications either mechanical or gastrointestinal. Feeding jejunostomy could be performed in 99.5% patients; 6.0% of the patients had a blocked catheter during the course of feeding. The target calorie requirement could be achieved in 78% of patients by third day. In all, 95% of patients could be successfully fed exclusively by jejunostomy catheter during the postoperative period. Minor gastrointestinal complications developed in 15% of the patients and were managed by slowing the rate of infusion or administering medication. Patients spent a mean of 16.67 +/- 22.00 days (range 0-46 days) on jejunostomy feeding after surgery; however, 13% required prolonged jejunostomy feeding beyond 30 days. Altogether, 64% of the patients with an anastomotic leak and 50% of the patients with postoperative complications required catheter jejunostomy feeding beyond 30 days. The mean duration for which jejunostomy tube feeding was used was significantly higher for patients who developed anastomotic disruptions (33.05 +/- 16.24 vs. 14.69 +/- 19.04 days; p = 0.000) and postoperative complications (26.67 +/- 25.56 vs. 14.52 +/- 18.64 days; p = 0.000) when compared to those without disruption or complications. There were no serious complications related to the feeding catheter that required reintervention. There was no difference in the mean body weight or weight deficit at the end of 10 days and at 1 month in patients who developed complications or anastomotic disruption when compared to their counterparts. No patient died as a result of a complication related to the feeding jejunostomy. Tube jejunostomy feeding is an effective method for providing nutritional support in patients undergoing esophagectomy, and it allows home support for the subset who fail to thrive. Prolonged tube feeding was continued in patients developing anastomotic disruptions and postoperative complications. Feeding jejunostomy has a definitive role to play in the management of the patients undergoing esophagectomy.
    World Journal of Surgery 05/2009; 33(7):1432-8. · 2.36 Impact Factor
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    Article: Benefits Versus Risks: A Prospective Audit
    Vikas Gupta
    [show abstract] [hide abstract]
    ABSTRACT: BackgroundThe purpose of this prospectively collected database is to evaluate the safety, efficacy, and utility of postoperative jejunostomy feeding in terms of achieving nutritional goals and evaluating gastrointestinal and mechanical complications in patients undergoing esophagectomy. MethodsThe study included 204 consecutive patients who underwent esophagectomy for various benign and malignant conditions. All patients underwent Witzel feeding jejunostomy at the time of laparotomy. Patients were followed prospectively to record nutritional intake, type of feed administered, rate progression, tolerance, and complications either mechanical or gastrointestinal. ResultsFeeding jejunostomy could be performed in 99.5% patients; 6.0% of the patients had a blocked catheter during the course of feeding. The target calorie requirement could be achieved in 78% of patients by third day. In all, 95% of patients could be successfully fed exclusively by jejunostomy catheter during the postoperative period. Minor gastrointestinal complications developed in 15% of the patients and were managed by slowing the rate of infusion or administering medication. Patients spent a mean of 16.67±22.00days (range 0–46days) on jejunostomy feeding after surgery; however, 13% required prolonged jejunostomy feeding beyond 30days. Altogether, 64% of the patients with an anastomotic leak and 50% of the patients with postoperative complications required catheter jejunostomy feeding beyond 30days. The mean duration for which jejunostomy tube feeding was used was significantly higher for patients who developed anastomotic disruptions (33.05±16.24 vs. 14.69±19.04days; p=0.000) and postoperative complications (26.67±25.56 vs. 14.52±18.64days; p=0.000) when compared to those without disruption or complications. There were no serious complications related to the feeding catheter that required reintervention. There was no difference in the mean body weight or weight deficit at the end of 10days and at 1month in patients who developed complications or anastomotic disruption when compared to their counterparts. No patient died as a result of a complication related to the feeding jejunostomy. ConclusionsTube jejunostomy feeding is an effective method for providing nutritional support in patients undergoing esophagectomy, and it allows home support for the subset who fail to thrive. Prolonged tube feeding was continued in patients developing anastomotic disruptions and postoperative complications. Feeding jejunostomy has a definitive role to play in the management of the patients undergoing esophagectomy.
    World Journal of Surgery 04/2012; 33(7):1432-1438. · 2.36 Impact Factor
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Keywords

1st postoperative year
 
adjunct
 
catheter jejunostomy
 
complications
 
digestive tract surgery
 
higher rate
 
jejunostomy
 
jejunostomy catheter
 
jejunostomy-related complications
 
longitudinal Witzel catheter
 
longitudinal Witzel catheter jejunostomy
 
patients
 
postoperative complications
 
postoperative jejunostomy
 
retrospective analysis
 
upper digestive tract
 
upper digestive tract diseases