Hussein E Waliye1, G Paul Wright2, Caitlin McCarthy3, Jared Johnson3, Alex Scales3, Andrea Wolf4, Mathew Chung5. 1. Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, United States; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, United States. Electronic address: Hussein.waliye@grmep.com. 2. Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, United States; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, United States. 3. Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, United States. 4. Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, United States; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, United States. 5. Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, United States; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, United States. Electronic address: Mathew.Chung@spectrumhealth.org.
Abstract
BACKGROUND: Routine placement of jejunostomy tubes (JT) during pancreaticoduodenectomy (PD) is controversial. METHODS: A retrospective chart review of patients undergoing PD from 1/1/08 through 12/31/14 was performed. The patients were divided into groups by placement of JT. Outcome measures were 90-day morbidity, 90-day mortality, length of stay, rate of delayed gastric emptying (DGE), and JT-specific complications. RESULTS: 256 patients were included. There were no significant differences in 90-day morbidity (39.9% vs. 37.9%, p = 0.747), 90-day mortality (3.9% vs. 1.0%, p = 0.247) or TPN use (24.8 vs. 25.2%, p = 0.941) between those with and without JT, respectively. Patients with a JT had a higher rate of DGE (p < 0.001), longer hospital stay (14.3 vs. 11.6, p < 0.001), and longer time to solid intake (9.4 vs. 7.3, p < 0.001). Eleven patients (7.2%) with JT had tube-related morbidity. CONCLUSIONS: Routine placement of JT at the time of PD should be abandoned with efforts focused on preoperative nutrition optimization and early oral diet trials.
BACKGROUND: Routine placement of jejunostomy tubes (JT) during pancreaticoduodenectomy (PD) is controversial. METHODS: A retrospective chart review of patients undergoing PD from 1/1/08 through 12/31/14 was performed. The patients were divided into groups by placement of JT. Outcome measures were 90-day morbidity, 90-day mortality, length of stay, rate of delayed gastric emptying (DGE), and JT-specific complications. RESULTS: 256 patients were included. There were no significant differences in 90-day morbidity (39.9% vs. 37.9%, p = 0.747), 90-day mortality (3.9% vs. 1.0%, p = 0.247) or TPN use (24.8 vs. 25.2%, p = 0.941) between those with and without JT, respectively. Patients with a JT had a higher rate of DGE (p < 0.001), longer hospital stay (14.3 vs. 11.6, p < 0.001), and longer time to solid intake (9.4 vs. 7.3, p < 0.001). Eleven patients (7.2%) with JT had tube-related morbidity. CONCLUSIONS: Routine placement of JT at the time of PD should be abandoned with efforts focused on preoperative nutrition optimization and early oral diet trials.