Chapter 14 Open Jejunostomy Tube Placement
INTRODUCTION
Enteral nutrition is the preferred method of feeding patients who are unable to meet their caloric needs through the conventional oral route. Feeds are most commonly initiated via the stomach, but the jejunum is an acceptable alternative. Jejunal feeding tubes are often placed in patients who are at increased risk of aspiration of gastric contents. It is also an option when the stomach is not suitable for a gastrostomy tube because of previous surgery, distal obstruction, or disease. Jejunostomy tubes are also often placed during extensive enteric reconstructions in which delayed oral intake is anticipated. Such tubes provide distal access for enteral nutrition and help to avoid the need for parenteral nutrition and prolonged vascular access.1
OPERATIVE PROCEDURE
Upper Midline Incision
Intra-Abdominal Injuries with Midline Incision
To obtain access and adequate exposure of the jejunum for an open jejunostomy tube placement, an upper midline incision is the standard choice. Care should be taken if the patient has had prior laparotomies and, thus, has resultant scar tissue. Complications related to laparotomy incisions are discussed in Section I, Chapter 7, Laparoscopic Surgery.
Identification of the Jejunum
Incorrect Identification of the Ligament of Treitz
• Consequence
• Repair
• Prevention
Placement of the Pursestring Suture in the Antimesentric Jejunum
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