Association for Academic SurgeryFeeding jejunostomy during Whipple is associated with increased morbidity
Introduction
Although enteral nutrition is strongly preferred to parenteral nutrition in the early postoperative period after pancreaticoduodenectomy (PD), or Whipple procedure, a subset of patients will develop complications such as delayed gastric emptying or pancreatic fistula that preclude or limit their ability to achieve adequate caloric intake orally [1], [2], [3], [4]. Because these complications cannot be predicted a priori, some surgeons will routinely place feeding jejunostomy (FJ) catheters in all of their PD patients in an effort to ensure that those patients who do go on to develop delayed gastric emptying or pancreatic fistula will still have a route available for enteral nutrition [5]. Given the known constellation of complications that can occur with FJ catheter placement and use, however, it is not clear whether the inclusion of this adjunctive procedure impacts the incidence of early postoperative morbidity associated with PD [6], [7]. The objective of our analysis was to compare the early postoperative outcomes of patients undergoing PD with and without concurrent FJ tube placement.
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Materials and methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) participant user files for 2005 through 2009 were used for this retrospective analysis. All patients with a primary Current Procedure Terminology code for PD (48150, 48152, 48153, 48154) and postoperative International Classification of Diseases, Ninth Revision diagnosis codes for non-endocrine malignant (152, 156.1, 156.2, 156.8, 156.9, 157, 157.1, 157.2, 157.3, 157.8, 157.9, or 197.4) or benign
Results
A total of 4930 patients meeting our inclusion and exclusion criteria were included for analysis: 633 (11.9%) who had an FJ tube placed during PD (FJ group) and 4297 (87.2%) who did not (No FJ group). As shown in Table 1, there were many significant differences between patients with and without FJ tubes when analyzing the entire NSQIP sample of PD patients. Patients in the FJ group were more likely to be nonwhite, more likely to have preoperative renal dysfunction, more likely to have a final
Discussion
In this analysis of 4930 patients with pancreatic neoplasms, we demonstrate that the concurrent placement of an FJ catheter during PD is associated with a significant increase in early postoperative morbidity and length of postoperative hospitalization. Although our use of ACS NSQIP subjects in our study has several important limitations, our findings nevertheless suggest that FJ catheters should be placed selectively, and not routinely, in patients who require PD for neoplastic disease.
The
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Postoperative nutrition in the setting of enhanced recovery programmes
2023, European Journal of Surgical OncologyPredictors and outcomes of jejunostomy tube placement at the time of pancreatoduodenectomy
2019, Surgery (United States)Citation Excerpt :Of note, DGE shared many of the same preoperative and intraoperative risk factors as CR-POPF, consistent with earlier findings of a strong association between intra-abdominal abscess or CR-POPF with the development of secondary DGE.4,6,34,37,38 Similar to findings from other studies, JT placement was associated with increased rates of postoperative complications after PD.36 In addition, tube-specific complications are well-known, including increased rates of abdominal wall infections at the site of JT insertion.10,20,36,39,40
Pancreaticoduodenectomy and placement of operative enteral access: Better or worse?
2019, American Journal of SurgeryCitation Excerpt :They found that feeding tube placement was associated with overall increased morbidity, including deep SSI, acute renal failure and sepsis. Unfortunately, this study was limited as the NSQIP database did not include data on procedure-specific complications such as POPF and DGE.5 There are several limitations to our study.