New Jejunostomy -Low Profile Button Jejunostomy-

Yoshifumi Sano, Yutaka Suzuki, Hiroshi Nimura, Hirotaka Kashimura, Yoshio Ishibashi, Sumio Takayama, Kohsuke Takeuchi*, Hiroshi Mashiko*, Nobuyoshi Hanyu and Teruaki Aoki*

Department of Surgery, The Jikei University School of Medicine
Department of Surgery, Mashiko Hospital*

Background: We developed low profile button jejunostomy (LBJ) using a Bard Button for those undergoing total gastrectomy to improve their nutrition status and quality of life (QOL). We detail the procedure and LBJ effects in patients. Patients and Methods: Subjects were 23 patients undergoing Roux-en Y reconstruction after total gastrectomy. We conducted LBJ on the afferent limb during reconstruction process and started nutrient administration through the Bard Button after surgery. We assessed LBJ usefulness in nutrition, results of a questionnaire given to patients, complications, performance status, working status, hospital stay and outcome of the chemotherapy after surgery. Results: Of the 23 patients, 21 (91.3%) used home enteral nutrition support through the Bard Button for 6 months after surgery. Mean serum transferrin, prealbmin, and retinol binding protein increased after surgery, although a body mass index (BMI) decrease was observed. The postoperative questionnaire, answered by 22 patients, indicated that Bard Button management was not complicated for patients. The questionnaire also represented that almost patients did not get annoyed with LBJ in daily life. We had no severe complications concerning the LBJ. Six patients (26.1%) had no change in performance status (PS), according to the Eastern Cooperative Oncology Group, after surgery, although 17 (73.9%) showed deteriorated PS. Deterioration, however, appeared less than expected. Sixteen patients changed from PS0 to PS1 and one 70 years old patient undergoing home cancer chemotherapy from PS1 to PS2, respectively. Median first hospital stay after surgery was 22 days. Three patients needed the other hospital stay in 6 months after surgery. Two of them were more than 70 years old and 1 underwent home cancer chemotherapy after surgery. Seven patients could undergo 3.3 courses home cancer chemotherapy using S-1, which was administrated orally for 4 weeks followed by a 2-week break a course, on the average in 6 months after surgery. The response for cancer chemotherapy was assessed according to the RECIST criterion. We observed one patient as PR, 5 as SD and 1 as PD respectively. Conclusions: We report a new type of jejunostomy, low profile button jejunostomy, for enteral nutrition support. Its surgical implementation was safe and easy, and it helped patients to have enteral nutrition support at home so that patients with LBJ maintain long good nutrition after surgery. LBJ may thus contribute to improve QOL after total gastrectomy.

Key words
gastric cancer, total gastrectomy, jejunostomy, enteral nutrition

Reprint requests
Yoshifumi Sano Department of Surgery, The Jikei University School of Medicine
3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461 JAPAN

Accepted
October 29, 2003

To read the PDF file you will need Abobe Reader installed on your computer.