A simplified technique for laparoscopic jejunostomy and gastrostomy tube placement

BACKGROUND: Percutaneous endoscopic gastrostomy and jejunostomy tube placem ent have long been considered the standard for supplying enteral nutrition when oval intake is not possible. Both have well-documented roles and limit ations and are associated with a higher than generally appreciated incidenc e of aspiration. A distally placed tube in the jejunum decreases the chance of this morbid complication. Additionally, when percutaneous endoscopic ga strostomy is indicated but cannot be done for technical reasons, a minimall y invasive alternative is desirable. METHODS: In prior series, the techniques suggested for laparoscopic enteral access have characteristics that are either difficult for the average surg eon to duplicate, or use nonstandard anchoring techniques of the bowel to t he abdominal wall. A simple, laparoscopically directed, percutaneous techni que utilizing cost-effective appliances is described, and suggested indicat ions are outlined. RESULTS: This technique has been successfully applied in 46 patients with minimal complications. CONCLUSIONS: A simplified technique for laparoscopic jejunostomy and gastro stomy tube placement is described. This has been successfully deployed in 4 6 patients with minimal morbidity. The procedure lessens the need for sophi sticated suturing skills and duplicates standard small bower to abdominal w alt fixation methods. Am J Surg. 1999;177:61-65. (C) 1999 by Excerpta Medic a, Inc.