Two port video-assisted gastrostomy and jejunostomy: technical simplification and clinical results

Laparoscopic vs. open feeding jejunostomy: a systemic review and meta-analysis

BACKGROUND

Feeding jejunostomy is a solid way for patients to maintain enteral nutrition. However, debate over the superiority of the laparoscopic vs. laparotomic method has raised concerns in recent years. This systemic review and meta-analysis aimed to compare the postoperative outcomes between these two approaches.

METHODS

We searched PubMed, Embase, and Scopus from the date of inception to April 2022 for studies comparing laparoscopic and open feeding jejunostomy. Study characteristics and outcomes were extracted from the included articles. The primary outcome was the relative risk (RR) of postoperative complications in each group. We also analyzed the major/minor complication rates and operations, excluding major concomitant procedures. The risk of bias of included studies were assessed using the ROBINS-I tool. The certainty of evidence was rated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

A total of seven retrospective studies with 1195 patients in total were included in this systemic review and meta-analysis. Laparoscopic feeding jejunostomy carried a significantly lower postoperative complication rate (RR: 0.62; 95% CI, 0.42-0.91, p = 0.02, low certainty of evidence) compared with laparotomy, and the heterogeneity was moderate (I² = 34%, p = 0.18). After excluding major concomitant procedures, the RR between the laparoscopic and open group was 0.48 (95% CI, 0.33-0.70, p < 0.001, low certainty of evidence), suggesting that the laparoscopic approach was superior in terms of postoperative complications.

CONCLUSIONS

Our results indicate that laparoscopic feeding jejunostomy might reduce the postoperative overall complication rate compared with open feeding jejunostomy.

Video-Assisted Jejunostomy Tube Placement With Two Portals: Surgical Technique in Ten Steps

Objectives. Endoscopic gastrostomy occasionally presents limitations such as costs, availability of equipment and special materials, and difficult access to the gastric cavity in the setting of obstructive esophageal tumors. Open jejunostomies present high rates of postoperative complications and limited capacity for abdominal evaluation due to reduced incision size. Thus, to reduce procedure-related complications and overall costs and provide a thorough intraoperative evaluation of the peritoneal cavity, we present the following simplified technique. Methods. Video-assisted jejunostomy in ten steps. Results. The use of this Video-assisted laparoscopic technique proves to be a safe, viable alternative, with cost reduction, decreased use of disposable materials, shortened operative time, and accelerated recovery, in addition to increased technical ease and wide applicability across a variety of hospital settings.

Minimally invasive technique for gastrostomy tube insertion: A novel laparoscopic approach

INTRODUCTION

Percutaneous endoscopic gastrostomy (PEG) is the most common way of inserting a gastrostomy tube. If PEG is not appropriate for a patient, then the laparoscopic or open technique should be used. Here, we introduce a new laparoscopic technique for inserting a gastrostomy tube.

MATERIAL AND SURGICAL TECHNIQUE

We used this new laparoscopic approach in 21 patients for whom PEG was not suitable. After marking on the abdominal skin and inserting the trocars, two 2-0 silk sutures were passed. Two stitches were placed 2 cm apart in the stomach with one hand. Each suture was pulled out with the fascia closure, the stomach was pulled out with a Babcock, and a purse-string suture using a round 2-0 silk suture was placed outside the stomach, creating a mushroom-retained gastrostomy.

CONCLUSION

This new laparoscopic technique is minimally invasive. It provides full control through only two trocars and required smaller incisions than common laparoscopic approaches. This method can be used to insert a gastrostomy tube in indicated patients when PEG placement is not suitable.

A New Method for Laparoscopic Stamm Gastrostomy

BACKGROUND/OBJECTIVE

Many methods of laparoscopic gastrostomy have been described, but in the majority of these, purse-string sutures and fixation of the stomach to the abdominal wall are not performed simultaneously. In this study, we aim to present a new laparoscopic gastrostomy tube (GT) placement method developed in accordance with the classical Stamm method.

MATERIALS AND METHODS

Intracorporeal purse-string suture is placed at the anterior wall of the stomach where the GT is intended to be placed. While purse-string sutures are being placed, in each bite, the needle is passed through from a loop thread prepared by extracorporeal and the two threads are suspended outside. The stomach is punctured with the hook cautery, the GT is inserted, and both threads are knotted outside the abdomen.

RESULTS

We prospectively placed GT by using our method in 16 patients with an average age of 5 years and most of them with neurological developmental delay. Fundoplication was performed in most of the cases in the same session. No complications were encountered.

CONCLUSIONS

Our method is a feasible approach for GT placement by the purse-string suturing and the fixation of the stomach to the abdominal wall without extending the port incision.