Laparoscopic technique for performing feeding jejunostomy via the gastric tube through the round ligament of the liver in minimally invasive esophagectomy with retrosternal reconstruction.

Abstract

Enteral nutrition after esophagectomy is commonly provided via jejunostomy; however, conventional jejunostomy carries the risk of small bowel obstruction (SBO). Feeding jejunostomy via the gastric tube (FJ‑GT), especially through the round ligament of the liver (RL), has been reported to reduce the risk of SBO or catheter site infection. However, previous reports have only described open procedures. We describe a novel laparoscopic technique for performing FJ‑GT through the RL during minimally invasive esophagectomy (MIE) with retrosternal reconstruction. Through an umbilical mini-laparotomy, the specimen was extracted, and a gastric tube was created. A jejunostomy catheter was inserted 30 cm into the duodenum from the gastric antrum, fixed to the gastric wall, and covered with the omentum. After retrosternal reconstruction, the catheter was laparoscopically exteriorized through the RL. Among the 75 consecutive patients, no catheter-related complications of Clavien-Dindo grade III or higher, including SBO, were observed. This technique is feasible and applicable in MIE.