S D Schwaitzberg1, D B Sable. 1. Department of Surgery, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
Abstract
BACKGROUND: In patients prone to recurrent aspiration, a feeding jejunostomy is only performed to ensure adequate nutrition. A popular method for placement of the jejunostomy tube is the Witzel procedure, employing a sersosal tunnel on the antimesenteric border. The Witzel procedure, however, frequently suffers from the complication of tube dislodgement and obstruction due to narrowing of the intestinal lumen. METHODS: To minimize the complications associated with the standard Witzel method, we modified the procedure wherein a T-tube is substituted for a standard French rubber catheter, and transversely sutured to the mesenteric border. We believe that the placement of the Witzel line in the transverse plane minimizes the risk of obstruction, and substitution of a T-tube for a standard French catheter should reduce the incidence of tube dislodgement. RESULTS: The Transverse Witzel T-tube feeding jejunostomy has been performed successfully in 30 patients without any complications of tube dislodgement or leaks, and no tube to date has been difficult to remove. Length of tube use has ranged from 1 to 6 months, and no postoperative complications have been observed in this group. CONCLUSIONS: The Transverse Witzel T-tube jejunostomy is an effective and rapid technique for placement of a feeding tube. No serious complications have been observed, and the complication of tube dislodgement appears to be decreased compared to the standard Witzel procedure.
BACKGROUND: In patients prone to recurrent aspiration, a feeding jejunostomy is only performed to ensure adequate nutrition. A popular method for placement of the jejunostomy tube is the Witzel procedure, employing a sersosal tunnel on the antimesenteric border. The Witzel procedure, however, frequently suffers from the complication of tube dislodgement and obstruction due to narrowing of the intestinal lumen. METHODS: To minimize the complications associated with the standard Witzel method, we modified the procedure wherein a T-tube is substituted for a standard French rubber catheter, and transversely sutured to the mesenteric border. We believe that the placement of the Witzel line in the transverse plane minimizes the risk of obstruction, and substitution of a T-tube for a standard French catheter should reduce the incidence of tube dislodgement. RESULTS: The Transverse Witzel T-tube feeding jejunostomy has been performed successfully in 30 patients without any complications of tube dislodgement or leaks, and no tube to date has been difficult to remove. Length of tube use has ranged from 1 to 6 months, and no postoperative complications have been observed in this group. CONCLUSIONS: The Transverse Witzel T-tube jejunostomy is an effective and rapid technique for placement of a feeding tube. No serious complications have been observed, and the complication of tube dislodgement appears to be decreased compared to the standard Witzel procedure.