Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6-7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications.
Enteral Nutrition ; Esophagectomy* ; Humans ; Jejunostomy* ; Nutritional Status

Recurrent tumour after radical pancreaticoduodenectomy may cause obstruction of the small bowel loop draining the liver. Roux-loop obstruction presents a particular therapeutic challenge, since the postsurgical anatomy usually prevents endoscopic access. Careful multidisciplinary discussion and multimodality preprocedure imaging are essential to accurately demonstrate the cause and anatomical location of the obstruction. Transhepatic or direct percutaneous stent placement should be possible in most cases, thereby avoiding long-term external biliary drainage. Gastropexy T-fasteners will secure the percutaneous access and reduce the risk of bile leakage. The static bile is invariably contaminated by gut bacteria, and systemic sepsis is to be expected. Enteral stents are preferable to biliary stents, and compound covered stents in a sandwich construction are likely to give the best long-term results. Transhepatic and direct percutaneous enteral stent insertion after jejunopexy is illustrated and the literature reviewed.
Anastomosis, Roux-en-Y ; Bacteria ; Bile ; Cholestasis ; Drainage ; Gastropexy ; Jaundice, Obstructive ; Jejunostomy ; Liver ; Pancreaticoduodenectomy ; Sepsis ; Stents

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.
Adult ; Aged ; *Anastomosis, Roux-en-Y ; *Esophagostomy ; Female ; *Gastrectomy ; Human ; *Jejunostomy ; Male ; Middle Age ; *Surgical Staplers

OBJECTIVETo investigate the application of home enteral nutrition (HEN) in patients with advanced gastric cancer and its impact on the quality of life.

METHODSData of 60 consecutive patients with advanced gastric cancer, who could not underwent operation and had relapse metastasis, from June 2010 to June 2012 were retrospectively analyzed. According to familial nutritional pattern, these 60 patients were divided into HEN group (25 cases) receiving home enteral nutritional support and control group (35 cases). HEN patients were supported through jejunostomy tube or nasal gastric tube. Control patients were supported through total parental nutrition or purely eating respectively. All the patients received intravenous chemotherapy and evaluated by Karnofsky index and Spitzer system in the first, third, sixth and twelfth month. In the sixth month, patients were also examined by EORTC QLQ-C30.

RESULTSNo significant differences were found between the two groups according to 8 elements containing age, sex, BMI, etc. A total of 53 patients died within one year, including 21 in HEN group and 32 in control group. The Karnofsky scales showed that HEN group scored meanly 57.4, 39.6 and 28.2 in the third, sixth and twelfth month respectively, which were significantly higher than those of control group (45.3, 29.2 and 20.1, P=0.041, P=0.012 and P=0.015 respectively). The Spitzer scales showed that HEN group scored meanly 5.12, 4.04 and 2.54 on average in the third, sixth and twelfth month respectively, which were significantly higher than those of control group (4.32, 3.01 and 1.97, P=0.048, 0.035 and P=0.024 respectively). The EROTC QLQ-C30 scales showed that HEN group scored higher than control group in functional scales (P<0.05), and lower in the symptom scales of short breathing, pain and tired (P=0.025, P=0.044, P=0.036 respectively), while higher in diarrhea (P=0.047).

CONCLUSIONSThe quality of life of patients with advanced gastric cancer declines gradually with the nutritional status deteriorating. HEN can be applied to improve the nutritional status and quality of life.

Malnutrition and weight loss after total gastrectomy is one of the major concerns of surgeons. In order to improve the nutritional status in these patients, many surgeons have tried to restore the duodenal passage as reconstructive procedure but debates have been continued. So we investigated weight change, postprandial serum secretin response and fecal fat amount to evaluate the esophagojejunoduodenostomy after which the duodenal passage was restored. Total gastrectomized dogs showed significant weight loss and all experimental animals except sham operation died between five and eight weeks after the operation. Serum secretin concentration after esophagojejunoduodenostomy increased significantly from a mean fasting value of 100 +/- 12.5 pg/mL to a mean peak of 142 +/- 22.5 pg/mL at 40 minutes and returned to the fasting level at 120 minutes postprandially. But fasting and postprandial serum secretin concentration in patients following Roux-en Y esophagojejunostomy were fluctuated irregularly. The amount of fecal fat in esophagojejunoduodenostomy was 5.3 +/- 1.2 gm/100 gm stool, which was not different from that of the control group but in Roux-en Y esophagojejunostomy it was 28.1 +/- 4.1 gm/100 gm stool which was much higher than that observed in esophagojejunoduodenostomy and in control group. These results suggest that esophagojejunoduodenostomy is superior to Roux-en Y esophagojejunostomy in respect to pancreatic secretory function and fat absorption.
Anastomosis, Roux-en-Y ; Animal ; *Animal Nutrition ; Dogs ; Duodenostomy ; Esophagostomy ; *Gastrectomy ; Jejunostomy ; Support, Non-U.S. Gov't

Gastrostomy placement for nutritional support for patients with inadequate oral intake has been attempted using surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy has been superseded by both endoscopic and radiologic gastrostomy. We describe herein the indications, contraindications, patient preparations, techniques, complications, and aftercare with regard to radiologic gastrostomy. In addition, we discuss the available tube types and their perceived advantages. There remain some controversies regarding gastropexy performance and primary percutaneous gastrojejunostomy. Percutaneous jejunostomy is indicated for patients whose stomach is inaccessible for gastrostomy placement or for those who have had a previous gastrectomy.
Aftercare ; Enteral Nutrition ; Gastrectomy ; Gastric Bypass ; Gastropexy ; Gastrostomy ; Humans ; Jejunostomy ; Nutritional Support ; Stomach

Esophagectomy has a high morbidity rate, mainly related to pulmonary complications. The respiratory morbidity of open esophagectomy is high, ranging from 6% to 10%. This high morbidity is partially responsible for the 6~15% mortality rate of esophagectomy. Many techniques of esophagectomy without thoracotomy have been described since the initial report of Orringer and Sloan. Endoscopic microsurgical dissection of the esophagus was clinically introduced in 1989. Endoscopic microsurgical dissection of the esophagus was developed as a minimally invasive procedure that avoids thoracotomy and provides precise vision during the operation in order to reduce mediastinal trauma and to improve the peri-and post-operative situation. A 20 year-old women who accidentally swallowed about 150 cc of glacial acetic acid underwent an esophagectomy using the operating mediastinoscopy, cervical esophagogastric anastomosis, pyloromyotomy, and feeding jejunostomy tube placement for esophageal stricture. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day. Our clinical experience shows that endoscopic microsurgical dissection of esophagus is a safe and feasible method because it offers excellent optical control and enables the surgeon to operate in a minimally invasive manner.
Acetic Acid ; Esophageal Stenosis ; Esophagectomy* ; Esophagus ; Female ; Humans ; Jejunostomy ; Mediastinoscopes* ; Mediastinoscopy ; Mortality ; Thoracotomy ; Young Adult

Parkinson's disease is a relatively common neurologic disorder that afflicts approximately 1% of the population over 50 years old. Many drugs currently used for the treatment of Parkinson's disease may interact with anesthetic drugs. Brief interruption of levodopa during surgery may result in exacerbation of Parkinson's symptoms. However, safe and effective way to administer levodopa during surgery are not widely known. We report the perioperative treatment of a patient with Parkinson's disease by using intraoperative administration of levodopa through nasogastric tube and feeding jejunostomy tube. This method of levodopa administration successfully prevented the exacerbation of Parkinsonian symptoms.
Anesthetics ; Humans ; Jejunostomy ; Levodopa* ; Middle Aged ; Nervous System Diseases ; Parkinson Disease*

Sorafenib, an oral multi-kinase inhibitor, is used for the treatment of patients with radioactive iodine (RAI) refractory differentiated thyroid carcinoma (DTC) with favorable outcomes. Some unusual but fatal adverse effects are known for this drug and tracheoesophageal fistula (TEF) is one of them, which has never been reported in thyroid cancer patients. We present a successfully treated patient who had developed TEF associated with rapid tumor regression during sorafenib treatment for locally advanced papillary thyroid carcinoma (PTC). Sorafenib was discontinued and feeding jejunostomy tube was placed for nutritional support. 3 months later, the TEF had successfully healed and there was no visible fistula track or interval change of the viable tumor during 15 months of follow-up. Identifying patients at high risk for this potential complication and paying special attention when prescribing anti-angiogenics to these patients are crucial to prevent associated morbidity and mortality.
Fistula ; Follow-Up Studies ; Humans ; Iodine ; Jejunostomy ; Mortality ; Nutritional Support ; Thyroid Gland* ; Thyroid Neoplasms* ; Tracheoesophageal Fistula*

BACKGROUND & PURPOSE: The most popular anastomotic method for a Billroth-II gastrectomy is an 'Albert-Lembert' type two-layer gastro jejunostomy (G-Jstomy) which seems more secure than a 'Gambee' type single-layer anastomosis which provides better mucosal apposition. Since 1995, I have used linear-type staplers during a Billroth-II gastrectomy and palliative bypass surgery for gastric cancer patients to make the G-Jstomy more convenient. There use shortened the operating time and made the gastrojejunostomy easier. I reviewed four years of stapling experience to prove the merits of a stapled G-Jstomy so as to encourage the surgeons who hesitate to do so for fear of complications. METHODS: 1,049 Billroth-II gastrectomies and 133 palliative gastrojejunostomies were carried out from January 1995 to December 1998 at Asan Medical Center. A linear stapler was used in 319 of the above procedures. RESULTS: A linear stapler with two rows of staples was used without any anastomotic leakage or hemorrhage. However, I experienced several efferent jejunal loop obstructions due to adhesion around the anastomosis at the beginning of the trial. All the adhesions occurred at the suture materials of stapler port which was closed manually. No more obstructions were observed after modifying the location of and the closing method for the stapler port. Nowadays, conventional manual G-Jstomy has been safely replaced with a stapled G-Jstomy. CONCLUSION: This report of a clinical trial offers a safe technique for a stapled G-Jstomy by solving the pitfalls.
Anastomotic Leak ; Chungcheongnam-do ; Gastrectomy ; Gastric Bypass* ; Hemorrhage ; Humans ; Jejunostomy ; Stomach Neoplasms ; Sutures