OBJECTIVE: Patients with pancreatic disease are often malnourished because of biliary and gastric outlet obstruction or the catabolic response to sepsis or cancer. In this study, we reviewed our experience of providing enteral nutrition through a T-tube jejunostomy in these patients. METHODS: The records of a consecutive series of 36 patients who had undergone pancreatic operations during the last 4 years were reviewed. Data were collected on preoperative nutritional status and postoperative feeding. RESULTS: All patients had partially hydrolysed feeds administered through a T-tube jejunostomy, placed during pylorus-preserving proximal pancreatoduodenectomy (21 patients), Whipple's procedure (4), debridement of pancreatic necrosis (3), palliative bypass (2), distal pancreatectomy (2), cyst-jejunostomy (3) or accessory sphincteroplasty (1). Tube feeding was employed for a mean of 18 days. There were no related deaths. Eight patients had complications directly attributable to the tube, including blockage (4), dislodgement (2), pericatheter leakage (2) and peritonitis (1). Twenty patients had complications related to feeds that included transient diarrhoea (13), abdominal distension (8), nausea or vomiting (6) and pain (6). Consequently, nitrogen and energy needs were completely fulfilled in only 19 patients. CONCLUSION: Despite many minor shortcomings, jejunostomy tube feeding appears to be a safe adjunct to pancreatic surgery.
OBJECTIVE:Patients with pancreatic disease are often malnourished because of biliary and gastric outlet obstruction or the catabolic response to sepsis or cancer. In this study, we reviewed our experience of providing enteral nutrition through a T-tube jejunostomy in these patients. METHODS: The records of a consecutive series of 36 patients who had undergone pancreatic operations during the last 4 years were reviewed. Data were collected on preoperative nutritional status and postoperative feeding. RESULTS: All patients had partially hydrolysed feeds administered through a T-tube jejunostomy, placed during pylorus-preserving proximal pancreatoduodenectomy (21 patients), Whipple's procedure (4), debridement of pancreatic necrosis (3), palliative bypass (2), distal pancreatectomy (2), cyst-jejunostomy (3) or accessory sphincteroplasty (1). Tube feeding was employed for a mean of 18 days. There were no related deaths. Eight patients had complications directly attributable to the tube, including blockage (4), dislodgement (2), pericatheter leakage (2) and peritonitis (1). Twenty patients had complications related to feeds that included transient diarrhoea (13), abdominal distension (8), nausea or vomiting (6) and pain (6). Consequently, nitrogen and energy needs were completely fulfilled in only 19 patients. CONCLUSION: Despite many minor shortcomings, jejunostomy tube feeding appears to be a safe adjunct to pancreatic surgery.
Authors: Duncan Rc Spalding; Kasim A Behranwala; Peter Straker; Jeremy N Thompson; Robin Cn Williamson Journal: Ann R Coll Surg Engl Date: 2009-06-25 Impact factor: 1.891