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Background
Laparoscopic gastrostomy (lap gtube) and Jejunostomy (lap j-tube) are relatively new
procedures that do not require laparotomy. Our aim was to determine the role of laparoscopic
feeding tube placement for enterai access and the safety of these techniques.
Methods
We reviewed our experience with attempted laparoscopic placement of 93 enterai tubes
in 81 patients over a 3-year period. Patients received either a lap g-tube (n = 64),
lap j-tube (n =− 5), or both lap g/j-tube (n = 12). When enterai access was needed
for nutritional support, the choice of lap g-tube or lap j-tube was based on risk
of gastroesophageal reflux.
Results
The most common underlying conditions requiring tube placement were head and neck
cancer (49%), neurologic disorders (19%), and trauma (11%). Mean operative times (minutes)
were as follows (mean ± SD): lap g-tube (39 ± 7), lap j-tube (63 ± 10), and lap g/j-tube
(85 ±13). Lap g-tube placement was successful in 73 (96%) of 76 patients and lap j-tube
in all 17 patients. The major complication rate for all tubes was 8% (7 of 93) and
included gastrointestinal bleeding, wound infection, and failed placement. Five patients
died in the 30-day period following surgery, but none of the deaths was procedure
related.
Conclusions
Laparoscopic tube placement should be considered for patients in whom endoscopy is
not feasible or undesirable or who are undergoing other operative procedures. Lap
gtube and lap j-tube are safe procedures that avoid the potential risk of a laparotomy,
and they can be done with a high success rate. This is a valuable approach for patients
with head and neck cancer or neurologic disorders and for trauma patients with multiple
disease processes.
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Article info
Footnotes
**Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
