A Trial comparing two different methods of feeding Jejunostomy

Job, N (2007) A Trial comparing two different methods of feeding Jejunostomy. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Enteral tube feeding is a valuable treatment modality in the management of both acute and chronic malnutrition. Recent advances in access devices, feeds and pumps have made enteral feeding a viable option for surgical patients. Nasoenteral feeding tubes avoid the risk of peritonitis as the placement of these tubes do not require an enterotomy. However they are easily displaced proximally or even completely displaced during vomiting or retching. While replacements can be done with radiological confirmation, 20% require more than one attempt and there is increased risk of the tube breaching a recent anastomosis. By contrast, a jejunostomy feeding tube is inserted under direct vision downstream to the most distal anastomosis and is not susceptible to postoperative displacement by vomiting. From the surgeon’s perspective this is a good way to deliver the maximum calories with the least procedure related morbidity and mortality. AIM OF THE STUDY: A trial to assess effectiveness and complication rates of two different methods of feeding jejunostomy (Foley’s catheter versus t – tube). OBJECTIVES: To study our experience regarding the effectiveness, postoperative complication rates and the final outcome between two different methods of feeding jejunostomy done in Department of General Surgery Unit IV and Unit III from July 2004 to July 2006. MATERIALS AND METHODS: Sample Size: It was proposed to have 150 patients in each arm of the study. This was calculated for 10% difference in the complication rates between the two groups with power of the study being 80. All patients undergoing major upper gastrointestinal operations including pancreatic, biliary and liver resections in Department of General Surgery Unit IV and Unit III were included in the study. Patients undergoing feeding jejunostomy as a palliative procedure or with unsuitable omentum (see later) were excluded from the study. The patients were allotted into two groups prior to surgery. One group received a standard Stamm’s feeding jejunostomy and the other group received t-tube feeding jejunostomy. Standard isocaloric enteral feed (1048 kcal and 40 g protein per litre) was infused into the jejunal feeding tube. Energy and fluid requirements were calculated according to individual patient needs taking into account total body weight. Infusion of feed commenced at 500ml of half strength feeds on day one and increased every day until the calculated target volume was reached (35 ml/kg body weight/day – e.g. for a 70 kg patient =2000–2500 kcal and 80–85 g of protein per day). Intravenous crystalloids were reduced proportionally as the enteral feeding was increased and discontinued once the target rate of enteral feeding was achieved. The aim was to maintain this rate until oral intake was established. Oral intake was established as soon as patient recovered and tolerated feeds. Enteral feeding was discontinued when a free oral fluid intake had been achieved, usually by the end of day 6 or 7. The outcome was defined as successful if jejunostomy was used for enteral nutrition after surgery and discontinued when patients achieved adequate oral nutrition or were discharged home on supplementary jejunal feeding. Patient details were entered in a proforma and then transferred on to a Microsoft Excel spread sheet. Data entry and analysis were done using SPSS 13. CONCLUSIONS: From this study, it can be concluded that 1. T-tube jejunostomy is as effective as Foley’s jejunostomy, 2. The complication rates between the 2 groups are comparable, 3. T- tube procedure is a simple and relatively quick procedure, 4. T- tube encourage the early formation of a fistulous tract permitting safe replacement in the event of tube dislodgement.

Item Type: Thesis (Masters)
Uncontrolled Keywords: two different methods ; feeding jejunostomy ; comparative study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 04 May 2018 02:12
Last Modified: 04 May 2018 02:12
URI: http://repository-tnmgrmu.ac.in/id/eprint/7417

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