Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To systematically evaluate the efficacy and safety of jejunostomy tube versus nasojejunal tube for enteral nutrition after radical resection of esophageal cancer. Methods    PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM databases were searched to collect the clinical effects of jejunostomy tube versus nasojejunal nutrition tube after radical resection of esophageal cancer from inception to October 2021. Meta-analysis was performed using RevMan 5.4 software. Results    Twenty-six articles were included, including 17 randomized controlled studies and 9 cohort studies, with a total of 35 808 patients. Meta-analysis results showed that: in the jejunostomy tube group, the postoperative exhaust time (MD=–4.27, 95%CI –5.87 to –2.66, P=0.001), the incidence of pulmonary infection (OR=1.39, 95%CI 1.06 to 1.82, P=0.02), incidence of tube removal (OR=0.11, 95%CI 0.04 to 0.30, P=0.001), incidence of tube blockage (OR=0.47, 95%CI 0.23 to 0.97, P=0.04), incidence of nasopharyngeal discomfort (OR=0.04, 95%CI 0.01 to 0.13, P=0.001), the incidence of nasopharyngeal mucosal damage (OR=0.13, 95%CI 0.04 to 0.42, P=0.008), the incidence of nausea and vomiting (OR=0.20, 95%CI 0.08 to 0.47, P=0.003) were significantly shorter or lower than those of the nasojejunal tube group. The postoperative serum albumin level (MD=5.75, 95%CI 5.34 to 6.16, P=0.001) was significantly better than that of the nasojejunal tube group. However, the intraoperative operation time of the jejunostomy tube group (MD=13.65, 95%CI 2.32 to 24.98, P=0.02) and the indent time of the postoperative nutrition tube (MD=17.81, 95%CI 12.71 to 22.91, P=0.001) were longer than those of the nasojejunal nutrition tube. At the same time, the incidence of postoperative intestinal obstruction (OR=6.08, 95%CI 2.55 to 14.50, P=0.001) was significantly higher than that of the nasojejunal tube group. There were no statistical differences in the length of postoperative hospital stay or the occurrence of anastomotic fistula between the two groups (P>0.05). Conclusion    In the process of enteral nutrition after radical resection of esophageal cancer, jejunostomy tube has better clinical treatment effect and is more comfortable during catheterization, but the incidence of intestinal obstruction is higher than that of traditional nasojejunal tube.

A Case of Malignant Gastrointestinal Obstruction in a Hyponutritional State That Was Treated with Staging Laparoscopy and Laparoscopic Jejunostomy to Enable Oral Intake

Treatment for malignancy bowel obstruction (MBO) includes surgery, gastrointestinal stenting, nasogastric tube, percutaneous endoscopic gastrostomy, and drug therapy. Drug therapy such as octreotide acetate significantly reduces the quality of life of patients because oral intake is no longer possible and continuous intravenous infusion is required. After a multidisciplinary conference including the department of gastrointestinal surgery and the department of palliative medicine, we could perform staging laparoscopy on a nutritionally-depleted patient with MBO and laparoscopic jejunostomy as a palliative surgery. As a result, she could discontinue from administration of octreotide acetate and resume oral intake.

Necrosis intestinal, una complicación infrecuente de la nutrición enteral por yeyunostomía / Mesenteric necrosis, a rare complication of feeding jejunostomy

RESUMEN La nutrición enteral es parte importante del soporte vital avanzado en el paciente crítico, y ha demostrado ser más fisiológica, económica y con resultados superiores a la nutrición parenteral. La yeyunostomía para alimentación enteral está indicada cuando no es posible la alimentación por vía oral y está contraindicada la utilización de una sonda nasogástrica o nasoyeyunal de alimentación. Es una vía de alimentación con escasa morbilidad, aunque no está exenta de complicaciones, y algunas de ellas pueden ser graves. Comunicamos un caso de necrosis intestinal vinculado a la alimentación enteral por yeyunostomía en un paciente sometido a una gastrectomía oncológica.

ABSTRACT Enteral nutrition is an important component of advanced life support in the critically ill patient, and has demonstrated to be more physiologic, cheaper and with better results than parenteral nutrition. Jejunostomy for enteral nutrition is indicated when the oral route is impossible and the use of a nasogastric or nasojejunal feeding tube is contraindicated. Although the rate of complications associated with enteral nutrition through jejunostomy is low, they may occur and be serious. We report a case of bowel necrosis associated with a jejunostomy performed for enteral nutrition in a patient who underwent oncologic gastrectomy.

Objective Assessment of Superiority of Enteral Feeding by Traditional Home Kitchen-Based Feed V/S Commercial Formula Feed in Patients of Esophagogastric Corrosive Injury

Background: Corrosive ingestion can cause severe chemical injury to upper gastrointestinal tract which leads to dysphagia, malnutrition and weight loss. Early nutritional assessment and support through feeding jejunostomy is important and it should be nutritionally optimum and economically balanced. The aim is to compare cost and nutritional status after nutritional support with traditional home kitchen made and commercial formula feed through feeding jejunostomy.Methods:A prospective study included patients on enteral nutrition based on traditional home kitchen feed (cohort-1) and on commercial formula feed (cohort-2). Patient抯 body weight, BMI, haemoglobin, serum albumin, nutritional risk index, controlling nutritional status score were checked at the admission, 3rd and 6th month follow up.Results: In cohort 1 mean albumin and haemoglobin raised by 33.13% & 14.60% at 3rd month and 47.23% & 22.3% at 6th month respectively; In cohort 2 it was 9.12% & 2.69% at 3rd month and 17.62% & 6.53% at 6th month respectively. At 6th month in cohort 1 and 2 mean weight gain was 7.56% & 4.0%; mean increase in NRI was 34.78% & 11.5% respectively. Mean CONUT score at six months was better improved in cohort 1 which is 6 to 1 as compared to cohort 2 which was 6 to 3. Mean monthly cost of home-based feeds was significantly lower as compared to commercial feeds (62.14 Rs v/s 682-2354 Rs/day).Conclusions:In corrosive GI tract injury patient enteral nutrition with traditional home kitchen-based feeds is safe, cost effective and associated with better improvement in nutritional status objective parameters.

Meta-analysis of the safety and efficacy assessment for the jejunostomy tube placement during the radical resection for gastric carcinoma / 国际外科学杂志

Objective:To investigate the safety and efficacy of indignant jejunostomy tube in radical resection of gastric carcinoma.Methods:Using "radical gastrectomy, esophagectomy, jejunostomy, enteral nutrition" as the Chinese search terms and "gastrectomy, esophagectomy, jejunostomy, jejunostomies, enteral nutrition" as the English search terms searched Pubmed, MEDLINE, EMbase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang and CBMdisc. The Chinese and English literatures published at home and abroad on indwelling and non-indwelling jejunostomy tubes after radical resection of gastric carcinoma from January 2010 to December 2020 were collected, including randomized controlled trial and cohort studies. The main outcome measure was the length of hospital stay; the secondary outcome measure was the overall postoperative complication rate, postoperative pulmonary infection rate, intestinal obstruction rate, and body weight changes at 3 and 6 months after radical gastrectomy. Meta-analysis was conducted using RevMan 5.2 software.Results:Finally, 12 articles with a total of 2 173 patients were included. Compared with the non-indwelling jejunostomy tube group, the patients in the indwelling group had a longer hospital stay ( WMD=2.05, P=0.01) and a higher incidence of intestinal obstruction ( OR=11.67, P<0.001). The incidence of overall postoperative complications ( OR=1.24, P=0.31), the incidence of postoperative pulmonary infection ( OR=1.43, P=0.13) and 3 months after radical gastrectomy ( WMD=0.58, P=0.24), 6 months ( P>0.05), the difference were not statistically significant. Conclusions:Indwelling jejunostomy tube placement after radical gastrectomy of gastric carcinoma did not show more therapeutic advantages, but prolonged the length of hospital stay and the probability of intestinal obstruction. Therefore, selective jejunostomy tube placement rather than routine jejunostomy placement should be required.

Surgical treatment in clinical stage iv gastric cancer: a comparison of different procedures and survival outcomes / Tratamento cirúrgico no câncer gástrico estágio clínico iv: uma comparação de diferentes procedimentos e resultados de sobrevida

ABSTRACT - BACKGROUND: Even in clinical stage IV gastric cancer (GC), surgical procedures may be required to palliate symptoms or in an attempt to improve survival. However, the limited survival of these patients raises doubts about who really had benefits from it. AIM: This study aimed to analyze the surgical outcomes in stage IV GC treated with surgical procedures without curative intent. METHODS: Retrospective analyses of patients with stage IV GC submitted to surgical procedures including tumor resection, bypass, jejunostomy, and diagnostic laparoscopy were performed. Patients with GC undergoing curative gastrectomy served as the comparison group. RESULTS: Surgical procedures in clinical stage IV were performed in 363 patients. Compared to curative surgery (680 patients), stage IV patients had a higher rate of comorbidities and ASA III/IV classification. The surgical procedures that were performed included 107 (29.4%) bypass procedures (partitioning/gastrojejunal anastomosis), 85 (23.4%) jejunostomies, 76 (20.9%) resections, and 76 (20.9%) diagnostic laparoscopies. Regarding patients' characteristics, resected patients had more distant metastasis (p=0.011), bypass patients were associated with disease in more than one site (p<0.001), and laparoscopy patients had more peritoneal metastasis (p<0.001). According to the type of surgery, the median overall survival was as follows: resection (13.6 months), bypass (7.8 months), jejunostomy (2.7 months), and diagnostic (7.8 months, p<0.001). On multivariate analysis, low albumin levels, in case of more than one site of disease, jejunostomy, and laparoscopy, were associated with worse survival. CONCLUSION: Stage IV resected cases have better survival, while patients submitted to jejunostomy and diagnostic laparoscopy had the worst results. The proper identification of patients who would benefit from surgical resection may improve survival and avoid futile procedures.

RESUMO - RACIONAL: Mesmo no câncer gástrico (CG) em estágio clínico IV (ECIV), procedimentos cirúrgicos podem ser necessários para aliviar sintomas ou na tentativa de melhorar a sobrevida. No entanto, a sobrevida limitada desses pacientes levanta dúvidas sobre quem realmente se beneficiaria. OBJETIVO: Analisar os resultados cirúrgicos do CG ECIV tratado com procedimentos cirúrgicos sem intenção curativa. MÉTODOS: Análise retrospectiva dos pacientes com CG ECIV submetido a procedimentos cirúrgicos, incluindo: ressecção tumoral, bypass, jejunostomia e laparoscopia diagnóstica. Pacientes submetidos à gastrectomia curativa serviram como grupo de comparação. RESULTADOS: Os procedimentos cirúrgicos em ECIV foram realizados em 363 pacientes. Comparado à cirurgia curativa (680 pacientes), os pacientes em ECIV apresentaram maior taxa de comorbidades e classificação ASA III/IV. Os procedimentos cirúrgicos realizados foram: 107 (29,4%) bypass (partição/anastomose gastrojejunal), 85 (23,4%) jejunostomias, 76 (20,9%) ressecções e 76 (20,9%) laparoscopias diagnósticas. Em relação às características dos pacientes, os ressecados apresentaram predomínio de metástases distantes (p=0,011); os de bypass associaram-se a doença em mais de um sítio (p<0,001); e os laparoscópicos, metástases peritoneais (p<0,001). A sobrevida global mediana de acordo com o tipo de cirurgia foi: ressecção (13,6 meses), bypass (7,8 meses), jejunostomia (2,7 meses) e diagnóstica (7,8 meses) (p<0,001). Na análise multivariada, níveis baixos de albumina, mais de um sítio de doença, jejunostomia e laparoscopia associaram-se a pior sobrevida. CONCLUSÃO: Pacientes em ECIV ressecados apresentam melhor sobrevida, enquanto aqueles submetidos à jejunostomia e laparoscopia diagnóstica tiveram piores resultados. A identificação adequada dos pacientes que se beneficiariam com a ressecção cirúrgica pode melhorar a sobrevida e evitar procedimentos pouco eficazes.

Re-do Laparoscopic Hepaticojejunostomy: Technique and Outcomes

Background & Aim: Roux-en-Y hepaticojejunostomy (RYHJ) is the most common treatment done for benign biliary strictures and as a part of for post CDC excision biliary drainage. In the long term follow up, RYHJ stenosis is a dreaded complication, both for the patients and the attending surgeon, in view of the complexity and difficulty in its management. This is traditionally managedby a combination of medical, radiological and open surgical techniques. There are only a few reports describing the management of strictured biliary anastomosis by a laparoscopic technique. The aim of the present study is to describe our experience of laparoscopic re- establishment of biliary continuity(Re-do hepatico-jejunostomy) Methods: Retrospective analysis of prospectively collected data of RYHJ stenosis post benign biliary stricture (BBS) repair and choledochal cyst (CDC) excision, treated by laparoscopic re-do RYHJ, between January 2018 to December 2018 in the department of GI Surgery, GB Pant Institute & Maulana Azad Medical College. Results: 6 patients underwent laparoscopic Re-do RYHJ during the study period. 4 patients developed RYHJ stenosis post open BBS repair and 2 after open CDC excision. The presenting complaints was repeated episodes of fever with jaundice, refractory to medical management. Three patients also had hepatolithiasis.

Damage control in penetrating duodenal trauma: less is better - the sequel / El control de daños en trauma penetrante de duodeno: "Menos es Mejor

Abstract The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.

Resumen El trauma de duodeno comúnmente se produce por un trauma penetrante que puede asociarse a lesiones vasculares y de órganos adyacentes. En el manejo quirúrgico se recomienda realizar un reparo primario o el empleo de técnicas quirúrgicas simples. Sin embargo, el abordaje de lesiones severas del duodeno es un tema controversial. Anteriormente, se han descrito técnicas como la exclusión pilórica o la pancreatoduodenectomía con resultados no concluyentes. El presente artículo presenta una propuesta del manejo de control de daños del trauma penetrante de duodeno, a través, de un algoritmo de cinco pasos. Este algoritmo plantea una solución para el cirujano cuando no es posible realizar el reparo primario. El control de daños del duodeno y su reconstrucción depende de una toma de decisiones respecto a la porción del duodeno lesionada y el compromiso sobre el complejo pancreatoduodenal. Se recomiendan medidas rápidas para contener el daño y se proponen vías de reconstrucción duodenal diferente a las clásicamente descritas. Igualmente, la probabilidad de complicaciones como fistula duodenales es considerable, por lo que proponemos, que el manejo de este tipo de fistulas de alto gasto se aborde por medio de una laparostomía retroperitoneal (lumbotomía). El abordaje del trauma penetrante de duodeno se puede realizar a través del principio "menos es mejor".

Swallowed dentures in thoracic oesophagus

Oesophagus is the second most (46.8%) common site of impaction of foreign body in the gastro-intestinal tract. Dentures constitute the 3rd most common (2.4%) foreign body in oesophagus of adults, following meat bone (76.1%) and coin (3.6%).In our Institute, impacted dentures in esophageal are referred to our department after a failed endoscopic venture at removal by ENT surgeons. Extraction in such a situation calls for judicial planning and careful timing of the procedure to achieve satisfactory results. The present study was done on 11 cases of thoracic oesophageal dentures which were removed surgically in the Department of CTVS Medical College and Hospital, Kolkata over 2 years of period. Between 1st October 2017 to 30st September 2019, 11 dentures were extracted from thoracic oesophagus via right postero-lateral thoracotomy approach. The defect in the oesophagus after denture removal was primarily closed; with reinforcement using intercostals muscle pedicled flap. A defunctioning cervical oesophagostomy and a feeding jejunostomy (FJ) were done in all cases. Surgical leaks were noted in 5 cases, of which 1 lady had fulminant mediastinitis before she died. Pneumonia was observed in 4 cases, superficial surgical wound infection in 2 cases, blocked FJ tube in 1 case and leakage following closure of cervical oesophagostomy in 3 cases. Thoracic esophageal dentures are serious surgical entities which need early diagnosis and management. Pre-operative optimization is very important for avoiding surgical leakage.

Early surgical management in pancreatic ascites on a background of chronic pancreatitis

Background: Pancreatic ascites can occur as a complication of acute or chronic pancreatitis. In majority of cases, it is associated with pseudocyst or duct disruption. Management is initially conservative with paracentesis with nutritional support. Early surgery has been recently contemplated as primary management for pancreatic ascites.Methods: A prospective study was done over a duration of three years from November 2017 to October 2019 in patients of chronic pancreatitis presenting with pancreatic ascites. All patients underwent pancreatic protocol contrast enhanced computed tomography abdomen and magnetic resonance cholangiopancreatography, duct diameter and main pancreatic duct (MPD) disruption site.  pseudocyst site was identified. After optimizing patients, early surgery was planned. Surgeries included either lateral pancreatic jejunostomy, if MPD were dilated. Pancreaticogastrostomy, cystogastrostomy or cystojejunostomy, if there was pseudocyst with extraneous impression over stomach or on mesocolon, and distal pancreatectomy (and/or) splenectomy. Results: Out of 20 cases of pancreatic ascites, 6 were of acute pancreatitis and conservatively managed and 14 were subjected to early primary surgery. 8 out of 14 patients underwent LPJ. 2/14 underwent pancreaticogastrostomy. 2/14 underwent cystogastrostomy and 1/14 underwent spleen preserving distal pancreatectomy. 1/14 underwent distal pancreatectomy and splenectomy. None of the patients had postoperative recurrence of pancreatic ascites. One patient developed Postoperative intra-abdominal collection which was drained. Mortality was 2/14 (14.2%), one died immediate postoperatively and another succumb to Pulmonary embolism on post-operative day-4. Pain scores were significantly reduced post-operatively.Conclusions: Primary early surgery directed towards primary pathology, as guided by MPD status, in selected patients with chronic pancreatitis with ascites leads to faster recovery of patient.

Short-term efficacy analysis of different surgical methods for Siewert type Ⅰ and Ⅱ esophagogastric junction carcinoma / 中国胸心血管外科临床杂志

@#Objective    To compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma. Methods    We selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed. Results    Among the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05). Conclusion    For Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.

Rectus abdominis muscle flap for repair of the gastrojejunal leakage after distal gastrectomy with Billroth II anastomosis for gastric cancer / Colgajo del músculo recto abdominal para reparación de la dehiscencia gastroyeyunal luego de gastrectomía distal con anastomosis Billroth II por cáncer gástrico

Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.

Las dehiscencias anastomóticas en el sitio de gastroyeyunostomía son difíciles de reparar, debido a la compleja anatomía gastrointestinal. Este es el primer estudio que comunica el uso clínico del colgajo del músculo recto abdominal (MRA) para la reparación de la dehiscencia de gastroyeyunostomía. A un paciente con dehiscencia de gastroyeyunostomía, luego de una gastrectomía distal con anastomosis Billrroth II para cáncer gástrico, se le realizó una reparación utilizando colgajo izquierdo del MRA, basado en la arteria epigástrica superior. El colgajo del músculo recto abdominal, después de ser extraído, se fijó a los bordes de la dehiscencia de la gastroyeyunostomía con pocas suturas de vicryl 2-0 interrumpidas. La dehiscencia de la gastroyeyunostomía fue sellada. El colgajo del músculo reto abdominal para el cierre del defecto gastrointestinal es un procedimiento simple, técnicamente fácil y confiable, que puede realizarse rápidamente en pacientes críticamente enfermos. Se puede utilizar para la reparación de un gran defecto gastrointestinal con bordes friables cuando el omento no está disponible o cuando otros métodos convencionales no son prácticos.

Interpretation of the Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy in adult patients / 中国实用护理杂志

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic Jejunostomy (PEJ) are common channels for enteral nutrition input. In the past five years, there are no relevant nursing guidelines and reviews in China. In August 2018, Wound, Ostomy and Continence Nurses Society (WOCN) issued the Clinical Practice Guidelines for Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy in Adults, including preoperative preparation, surgical procedure and postoperative monitoring of gastrostomy and Jejunostomy. The management of enteral nutrition tube, the use of enteral nutrition and drugs, the prevention of medication errors, the treatment of early and late complications, the education of patients and their caregivers, and the replacement of catheters are all recommended. This article interpreted the guideline in order to provide reference for clinical nursing of gastrostomy and Jejunostomy.

An observational comparison of totally endoscopic Ivor-lewis esophagectomy over assisted abdominal mini-incision / 中华胸心血管外科杂志

Objective Comparative study on efficacy and complications between totally laparo-thoracoscopic Ivor-Lewis esophagectomy(LTILE)combined with jejunostomy,and esophagectomy with assisted abdominal incision.Methods Clinical data of 160 patients with mid-lower thoracic esophageal cancer who underwent thoracoscopic laparoscopic oesophagectomy within the same therapeutic group from January 2017 to July 2018 were retrospectively analyzed.79 patients underwent totally LTILE combined with jejunostomy;the rest 81 patients had LTILE with assisted abdominal incision and nasointestinal tube placement.Preoperative,intraoperative and postoperative clinical data and complicatioos were analyzed.Results There was no significant difference between two groups,including operation time,intraoperative blood loss,number of lymph nodes dissection,postoperative drainage and total treatment cost.In terms of the postoperative pain scores within 3 days,incision complications,pulmonary infection rate and postoperative hospitalization time,there were significant differences(P ＜ 0.05).Conclusion Complete LTILE with jejunostomy appeared to render better short-term clinical outcomes.

Interpretation of the Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy in adult patients / 中国实用护理杂志

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic Jejunostomy (PEJ) are common channels for enteral nutrition input. In the past five years, there are no relevant nursing guidelines and reviews in China. In August 2018, Wound, Ostomy and Continence Nurses Society (WOCN) issued the Clinical Practice Guidelines for Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy in Adults, including preoperative preparation, surgical procedure and postoperative monitoring of gastrostomy and Jejunostomy. The management of enteral nutrition tube, the use of enteral nutrition and drugs, the prevention of medication errors, the treatment of early and late complications, the education of patients and their caregivers, and the replacement of catheters are all recommended. This article interpreted the guideline in order to provide reference for clinical nursing of gastrostomy and Jejunostomy.

Liquid Fire In The Stomach A Minimally Invasive Approach

Corrosive injuries are common in developing countries. Acid ingestion is more common in developing countries when compared to alkali ingestion in developed countries. Ingestion may be accidental or suicidal. The nature of the corrosive ingested determines the extent of injury caused. Acidic injury commonly affects stomach than alkalis and it ranges from acute to chronic gastric injuries. In this article we discuss about the management of corrosive stricture of pylorus of stomach which was dealt by laparoscopy.

Effect of enteral nutrition via a naso-gastric(intestinal) tube vs a percutaneous endoscopic gastrostomy/jejunostomy tube in patients after liver transplantation: a Meta analysis / 中华肝胆外科杂志

Objective To systematically review the effect of enteral nutrition via a naso-gastric (intestinal) tube (NG) vs a percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) after liver transplantation,and provide support for the selection of proper nutrition.Methods Pub Med,web of science,Cochrane Library (Jan,2018),CNKI,VIP and Wanfang Date were search until Jan,2018.Two authors independently assessed the trials for inclusion and extracted the data.Discrepancies were resolved in consultation with a third reviewer,about the research of retrospective study for the effects of enteral nutrition via NG vs PEG/PEJ after liver transplantation was performed and supplemented.Publication bias were evaluated,and Meta-analyses were conducted with RevMan5.3.Results 4 studies were collected,involving 430 patients.The Meta-analysis showed that starting time of enteral nutrition of PEG/PEJ was earlier than NG (MD =-1.77,95％ CI-1.83 to-1.70,P＜0.05).The average hospitalization time of PEG/PEJ was shorter than NG (MD=-2.88,95％CI-5.19 to-0.56,P＜0.05).The diarrhea incidence of PEG/PEJ was higher than NG (OR=1.66,95％CI 1.04 to 2.65,P＜0.05),and gastroesophageal reflux incidence of PEG/PEJ was lower than NG (OR=0.29,95％CI 0.12 to 0.66,P＜0.05).The gastric retention rate of PEG/PEJ was lower than NG (OR =0.26,95％ CI 0.14 to 0.41,P＜0.05).Dislocation incidence of PEG/PEJ was lower than NG (OR =0.06,95％CI 0.01 to 0.46,P＜0.05).The pneumonia incidence of PEG/PEJ tube was lower than NG (OR=0.59,95％CI 0.36 to 0.99,P＜0.05).There were no significant differences between PEG/PEJ and NG on indwelling time,occlusion,abdominal infection,acute renal insufficiency,and acute rejection reaction.Conclusion PEG/PEJ had earlier starting time of enteral nutrition,shorter hospitalization time,lower nutrition tube placement related complications such as gastric esophagus reflux,gastric retention,dislocation rate and lower incidence of pneumonia,but the incidence of diarrhea was higher.NG is the first choice after liver transplantation,and for patients with serious basic diseases,weak digestive function or digestive system disorders PEG/PEJ can be chosen.

Effects of percutaneous gastrojejunostomy on nutritional intake and prognosis in severe brain injury patients / 中华急诊医学杂志

Objective To evaluate the effects on nutritional intakes and clinical outcomes of severe brain injury patients receiving percutaneous gastrojejunostomy (PEG-J) feedings. Methods The severe brain injury patients treated in ICU of Changshu No.1 Hospital from Jan 2013 to Dec 2016 were enrolled in the study. Patients were randomized into: control group, patients received nasoduodenal feedings and treatment group, patients received PEG-J feedings. The feeding speed was adjusted according to the amount of gastric residual or reflux vomiting. The daily dose of enteral nutrition in the first week, endocrine function, immune function, nutritional states and clinical outcomes were recorded. Results Totally 87 patients were enrolled in this study, 45 patients in the control group and 42 patients in the treatment group. The daily dose of enteral nutrition of the treatment group were significantly more than the control group from the fourth to the seventh days (P= 0.001, <0.01, 0.024), the CD4+T-lymphocyte percentage and CD4+/CD8+ ratio were significantly higher in the treatment group on day 7 (P=0.03, 0.01), levels of thyroidstimulating hormone, free triiodothyronine and free thyroxine of the treatment group were higher (P=0.036, 0.013, 0.025), and the level of hormonal was lower in the treatment group (P=0.004).The levels of albumin, prealbumin and insulin dosage were not significantly different between the two groups, neither did mortality, rates of organ failures. But the treatment group has a higher Barthel index scores (P=0.049), shorter length of mechanical ventilation and stay ICU (P=0.044, 0.048), and the lower incidence of vomiting and ventilator associated pneumonia (P=0.013, 0.037). Conclusions PEG-J could increase energy intake, improve immunity and endocrine function, promote the recovery of life ability, reduce the incidence of VAP, shorten mechanical ventilation time and ICU stay in severe brain injury patients.

Fish-Mouth Closure of the Pancreatic Stump and Parachuting of the Pancreatic End with Double U Trans-Pancreatic Sutures for Pancreatico-Jejunostomy

PURPOSE: Leakage of pancreatico-jejunal anastomosis (PJ) remains the primary cause of morbidity and mortality after Whipple's operation. To reduce the occurrence thereof, the present author recently began to apply a modification of the Blumgart method of anastomosis after Whipple's operation (hereinafter referred to as Lee's method), with very good results. MATERIALS AND METHODS: The modified method and technique utilizes fish-mouth closure of a beveled pancreatic stump and parachuting of the pancreatic end with double U trans-pancreatic sutures (symmetric horizontal mattress-type sutures between the full thickness of the pancreas and the jejunal limb) after duct-to-mucosa pancreatico-jejunostomy. RESULTS: Eleven cases of pylorus preserving Whipple's operation have been performed without a clinically significant postoperative pancreatic fistula. CONCLUSION: This new method (Lee's method) may dramatically reduce the occurrence of postoperative pancreatic fistula after Whipple's operation.

Comparative study of Hepatico-duodenostomy Vs Hepatico-jejunostomy surgical procedures in the management of choledochal cyst in children

Background: Choledochal cyst is a congenital anomaly of the ducts of the extarhepaticbiliary tree. This condition is considered rare in the view of western population with an incidence of 1 in 100,000 to 150,000 births, while it defers in the Asian population where in the incidence is nearly 1 in 1000 live births. Aim: To compare and assess the advantages and disadvantages between the two standard procedures in the surgical management of choledochal cyst in children. Materials and methods: The required sample size was collected prospectively over a period of two years from November 2014 to October 2016. The decision for biliary-enteric anastomosis (Hepaticoduodenostomy Vs. Hepatico- jejunostomy) made was not influenced or directed by the study. The type of anastomosis was left to the surgeon’s personal preference in each case.15 cases of each type of biliary-enteric anastomosis – Hepatico-duodenostomy and Hepatico-jejunostomy were chosen. Results: The age distribution in cases undergoing hepatico-duodenostomy was almost near to equal, female to male ratio was of 1.25: 1. Out of 15 patients 5 in hepatico-duodenostomy group and 3 in hepatico-jejunostomy had a palpable mass in the right upper quadrant. This means that a palpable mass was seen in 26% of our patients who present for surgical correction of a CC. Second most important presenting complaint in CC was pain. Thirteen out of 30 children presented with bilious vomiting. On an average, we had initiation of feeds in the hepatico-duodenostomy group was of 5 K.V. Sathyanarayana, Sri Aparna Mummaneni. Comparative study of Hepatico-duodenostomy Vs. Hepatico-jejunostomy surgical procedures in the management of choledochal cyst in children. IAIM, 2018; 5(10): 127-137. Page 128 days and that of the hepatico-jejunostomy group was of 7 days. Average stay for the hepaticoduodenostomy group was around 7.6 days when compared to 10.5 days in the hepatico-jejunostomy group. One case in hepatico-jejunostomy group was seen to have bile leak on the 4 the post-operative day. No other early complications were seen in the hepatico-duodenostomy group. One child belonging to hepatio-duodenostomy group had been admitted three months post-operatively with the complaint of recurrent pain abdomen and fever. In cases of hepatico-duodenostomy, none of them presented with any symptoms of pain abdomen or recurrent vomiting. Conclusion: Our results also support HD as the preferred procedure for biliary reconstruction after resection of CC, in view of the advantages of relative simplicity, and low rate of complications.