The Optimal Feeding Enterostomy Creation During Esophagectomy to Reduce the Long-Term Risk of Small Bowel Obstruction.

ABSTRACT

BACKGROUND: Although feeding jejunostomy (FJ) is commonly created during esophagectomy for postoperative enteral nutrition, it can be a cause of postoperative small bowel obstruction (SBO). We introduced a technique of feeding enterostomy using the round ligament of the liver (FERL) to reduce SBO. In this study, we aimed to clarify the efficacy of FERL in reducing the postoperative SBO compared with FJ. METHODS: We assessed 400 consecutive patients who underwent esophagectomy with gastric tube reconstruction between 2011 and 2016, before and after the introduction of FERL (FJ, n = 200; FERL, n = 200). The cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy were compared between the FJ and the FERL groups. RESULTS: Thoracoscopic and laparoscopic surgery was more frequent in the FERL group than in the FJ group (p < 0.001). The cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy in the FERL group were significantly less frequent than those in the FJ group (p < 0.001 and p = 0.006, respectively). When stratifying by the abdominal surgical approach, the cumulative incidences of postoperative SBO and SBO associated with feeding enterostomy in a laparoscopic approach were less frequent in the FERL group than those in the FJ group (both p < 0.001). CONCLUSIONS: The FERL technique can reduce the incidences of postoperative SBO and SBO associated with feeding enterostomy in patients undergoing esophagectomy.