A laparoscopic jejunostomy is a surgical procedure for creating an opening into the small intestine to provide nutrition. The term “laparoscopic” describes the minimally invasive technique used, which involves small incisions in the abdomen and a camera called a laparoscope for visualization. “Jejunostomy” refers to the creation of a stoma, or opening, into the jejunum, the middle section of the small intestine. This procedure allows for the delivery of liquid nutrition, fluids, and medications directly into the digestive tract when a person is unable to eat or drink enough by mouth.
Medical Indications for a Jejunostomy
A jejunostomy is necessary when the stomach must be bypassed for feeding, but the lower parts of the digestive system are still functional. One common reason is severe gastroparesis, a condition where the stomach cannot empty itself of food. Patients with cancers affecting the esophagus or stomach may also require a jejunostomy if a tumor causes a blockage, or for nutritional support during treatments like chemotherapy.
Other conditions that may lead to this procedure include chronic pancreatitis, which requires the pancreas to rest, or a gastric outlet obstruction that prevents food from leaving the stomach. It is also considered for individuals who cannot safely swallow due to neurological disorders like a stroke or cerebral palsy, or those who experience recurrent aspiration pneumonia.
The Laparoscopic Procedure and Hospital Recovery
Preparation for a laparoscopic jejunostomy involves fasting for a set period before surgery, which is performed under general anesthesia. The patient will also undergo a physical examination and may have blood work or imaging studies performed.
The surgery begins with the surgeon making several small incisions in the abdomen. A laparoscope, a thin tube with a camera and light, is inserted through one incision, allowing the surgeon to view the abdominal organs on a monitor. Other small surgical instruments are inserted through the remaining incisions to gently handle the intestines and identify a suitable section of the jejunum.
Once the correct spot is located, the jejunum is brought toward the abdominal wall and secured with sutures. A small opening is made into the jejunum, and a feeding tube is inserted into the intestine. The other end of the tube is brought out through a separate small incision on the abdomen, creating the stoma. This laparoscopic technique results in less pain and a quicker recovery compared to traditional open surgery.
Following the procedure, the patient is monitored in a recovery room for several hours. Pain is managed with medication, and the incision sites are covered with dressings. Tube feedings are started slowly within a day or two, beginning with clear liquids and advancing to a specialized liquid formula. The hospital stay is between one and three days. Before discharge, patients and caregivers receive detailed instructions on how to care for the tube, administer feedings, and recognize potential issues.
Living with a Jejunostomy Feeding Tube
Daily cleaning of the skin around the stoma is important to prevent irritation and infection. This is done with mild soap and warm water, followed by gently patting the area dry. Dressings may be needed, especially in the beginning, to absorb any minor leakage and to secure the tube, which should be taped to the abdomen to prevent it from being accidentally pulled.
A prescribed liquid formula is delivered through the tube using a feeding pump. Feeding schedules can vary; some people receive a slow, continuous drip over many hours, while others may have more concentrated feedings at set times, known as bolus feedings. It is also necessary to flush the tube with water before and after each feeding and medication administration to prevent clogs.
Showering is permissible, though baths may be discouraged initially to allow the stoma site to heal completely. Sleeping positions may need slight adjustment to avoid lying directly on the tube. Many individuals are able to return to work, school, and participate in non-strenuous physical activities after consulting with their healthcare provider.
Managing Potential Complications
Tube-related problems are among the most common and include clogging, accidental dislodgement, and leakage of formula around the stoma. To prevent clogs, regular flushing with water is necessary. If the tube becomes dislodged, it is important not to attempt to reinsert it yourself; instead, contact your doctor immediately. Minor leakage can sometimes be managed by adjusting the tube’s position or applying a new dressing, but persistent leakage requires medical attention.
Site-related issues can also occur, primarily skin irritation or infection. Signs of an infection include increased redness, pain, swelling, or a foul-smelling discharge from the stoma. While mild skin irritation can sometimes be managed at home with thorough cleaning and drying, signs of infection warrant a call to a healthcare provider, who may prescribe antibiotics.