Feeding jejunostomy after pancreaticoduodenectomy: Benefit or burden?

Backgrounds/aims: Pancreaticoduodenectomy (PD) is the standard treatment for resectable tumors of the pancreatic head, ampulla, distal bile duct, and duodenum. Despite advances, delayed gastric emptying (DGE) remains a common complication. Feeding jejunostomy (FJ) is often used during PD, though its necessity and association with increased morbidity, particularly DGE, remain controversial. This study aimed to evaluate early postoperative outcomes in PD patients with or without FJ, focusing on DGE and related complications.

Methods: This prospective observational study was conducted from August 2022 to April 2024 and included 56 patients (28 with FJ, 28 without). Primary outcomes were DGE, postoperative pancreatic fistula (POPF), and hospital stay. Secondary outcomes included FJ-related complications, surgical site infections, and time to tolerate solid food. Statistical analysis was performed using SPSS v28.

Results: DGE was significantly more frequent in the FJ group (78.6% vs. 39.3%, p = 0.006). Clinically relevant DGE (grades B/C) was also higher with FJ (60.7% vs. 21.4%, p = 0.008). FJ-related complications, including intestinal obstruction requiring reoperation, occurred in 10.7% of patients. Time to tolerate solid food and hospital stay were longer in the FJ group. Multivariate analysis identified FJ use and perioperative blood transfusion as independent risk factors for DGE.

Conclusions: Routine FJ placement in PD is associated with increased DGE and tube-related complications. A selective approach to FJ may improve postoperative outcomes. Larger multicenter randomized trials are needed to validate these findings and develop clear guidelines for FJ use in PD.