Laparoscopic vs. open feeding jejunostomy insertion in oesophagogastric cancer

Abstract Background Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. Methods A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. Results In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs. 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). Conclusions This report represents the largest to our knowledge single-centre comparison of open vs. laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

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Laparoscopic versus open feeding jejunostomy insertion in oesophagogastric cancer

10.21203/rs.3.rs-45981/v2 ◽

2020 ◽

Author(s):

Sotiris Mastoridis ◽

Giada Bracalente ◽

Chistine-Bianca Hanganu ◽

Michela Neccia ◽

Antonio Giuliani ◽

...

Keyword(s):

Postoperative Morbidity ◽

Laparoscopic Approach ◽

Early Postoperative Period ◽

Insertion Technique ◽

Feeding Jejunostomy ◽

Nutritional Characteristics ◽

Laparoscopic Jejunostomy ◽

Enteral Access ◽

Open Versus ◽

Oesophagogastric Cancer

Abstract Background: Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. Methods: A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. Results: In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone procedure or in conjunction with laparoscopic staging (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). Conclusions: This report represents the largest to our knowledge single-centre comparison of open versus laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

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Laparoscopic versus open feeding jejunostomy insertion in oesophagogastric cancer

10.21203/rs.3.rs-45981/v3 ◽

2021 ◽

Author(s):

Sotiris Mastoridis ◽

Giada Bracalente ◽

Chistine-Bianca Hanganu ◽

Michela Neccia ◽

Antonio Giuliani ◽

...

Keyword(s):

Postoperative Morbidity ◽

Laparoscopic Approach ◽

Early Postoperative Period ◽

Insertion Technique ◽

Feeding Jejunostomy ◽

Nutritional Characteristics ◽

Laparoscopic Jejunostomy ◽

Enteral Access ◽

Open Versus ◽

Oesophagogastric Cancer

Abstract Background: Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. Methods: A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. Results: In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). Conclusions: This report represents the largest to our knowledge single-centre comparison of open versus laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

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Laparoscopic Versus Open Feeding Jejunostomy Insertion in Oesophagogastric Cancer

10.21203/rs.3.rs-45981/v1 ◽

2020 ◽

Author(s):

Sotiris Mastoridis ◽

Giada Bracalente ◽

Bianca Hanganu ◽

Michela Neccia ◽

Antonio Giuliani ◽

...

Keyword(s):

Postoperative Morbidity ◽

Laparoscopic Approach ◽

Early Postoperative Period ◽

Insertion Technique ◽

Feeding Jejunostomy ◽

Nutritional Characteristics ◽

Laparoscopic Jejunostomy ◽

Enteral Access ◽

Open Versus ◽

Oesophagogastric Cancer

Abstract Background Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. Methods A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. Results In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone procedure or in conjunction with laparoscopic staging (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). Conclusions This report represents the largest to our knowledge single-centre comparison of open versus laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

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Laparoscopic versus open distal pancreatectomy: a single centre propensity score matching analysis

Updates in Surgery ◽

10.1007/s13304-021-01039-x ◽

2021 ◽

Author(s):

Riccardo Casadei ◽

Carlo Ingaldi ◽

Claudio Ricci ◽

Laura Alberici ◽

Emilio De Raffele ◽

...

Keyword(s):

Propensity Score ◽

Hospital Stay ◽

Distal Pancreatectomy ◽

Pancreatic Neoplasms ◽

Postoperative Morbidity ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Single Centre ◽

Oncological Outcomes ◽

Open Distal Pancreatectomy

AbstractThe laparoscopic approach is considered as standard practice in patients with body-tail pancreatic neoplasms. However, only a few randomized controlled trials (RCTs) and propensity score matching (PSM) studies have been performed. Thus, additional studies are needed to obtain more robust evidence. This is a single-centre propensity score-matched study including patients who underwent laparoscopic (LDP) and open distal pancreatectomy (ODP) with splenectomy for pancreatic neoplasms. Demographic, intra, postoperative and oncological data were collected. The primary endpoint was the length of hospital stay. The secondary endpoints included the assessment of the operative findings, postoperative outcomes, oncological outcomes (only in the subset of patients with pancreatic ductal adenocarcinoma-PDAC) and total costs. In total, 205 patients were analysed: 105 (51.2%) undergoing an open approach and 100 (48.8%) a laparoscopic approach. After PSM, two well-balanced groups of 75 patients were analysed and showed a shorter length of hospital stay (P = 0.001), a lower blood loss (P = 0.032), a reduced rate of postoperative morbidity (P < 0.001) and decreased total costs (P = 0.050) after LDP with respect to ODP. Regarding the subset of patients with PDAC, 22 patients were analysed: they showed a significant shorter length of hospital stay (P = 0.050) and a reduction in postoperative morbidity (P < 0.001) after LDP with respect to ODP. Oncological outcomes were similar. LDP showed lower hospital stay and postoperative morbidity rate than ODP both in the entire population and in patients affected by PDAC. Total costs were reduced only in the entire population. Oncological outcomes were comparable in PDAC patients.

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Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention

BMC Surgery ◽

10.1186/s12893-021-01050-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hsin-I. Tsai ◽

Ta-Chun Chou ◽

Ming-Chin Yu ◽

Chun-Nan Yeh ◽

Meng-Ting Peng ◽

...

Keyword(s):

Postoperative Pain ◽

Intraoperative Complications ◽

Postoperative Outcome ◽

Early Enteral Nutrition ◽

Chang Gung Memorial Hospital ◽

Open Approach ◽

Feeding Jejunostomy ◽

Laparoscopic Jejunostomy ◽

Conventional Open Approach ◽

Laparoscopic Feeding Jejunostomy

Abstract Background Laparoscopic procedure has inherent merits of smaller incisions, better cosmesis, less postoperative pain, and earlier recovery. In the current study, we presented our method of purely laparoscopic feeding jejunostomy and compared its results with that of conventional open approach. Methods We retrospectively reviewed our patients from 2012 to 2019 who had received either laparoscopic jejunostomy (LJ, n = 29) or open ones (OJ, n = 94) in Chang Gung Memorial Hospital, Linkou. Peri-operative data and postoperative outcomes were analyzed. Results In the current study, we employed 3-0 Vicryl, instead of V-loc barbed sutures, for laparoscopic jejunostomy. The mean operative duration of LJ group was about 30 min longer than the OJ group (159 ± 57.2 mins vs 128 ± 34.6 mins; P = 0.001). There were no intraoperative complications reported in both groups. The patients in the LJ group suffered significantly less postoperative pain than in the OJ group (mean NRS 2.03 ± 0.9 vs. 2.79 ± 1.2; P = 0.002). The majority of patients in both groups received early enteral nutrition (< 48 h) after the operation (86.2% vs. 74.5%; P = 0.143). Conclusions Our study demonstrated that purely laparoscopic feeding jejunostomy is a safe and feasible procedure with less postoperative pain and excellent postoperative outcome. It also provides surgeons opportunities to enhance intracorporeal suture techniques.

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Laparoscopic approach for living donor to paediatric liver transplantation. A single centre experience of the first 5 cases in Spain

HPB ◽

10.1016/j.hpb.2019.10.671 ◽

2019 ◽

Vol 21 ◽

pp. S772-S773

Author(s):

J. Briceño ◽

R. Ciria ◽

P. Lopez-Cillero ◽

M.D. Ayllon ◽

A. Luque ◽

...

Keyword(s):

Liver Transplantation ◽

Living Donor ◽

Laparoscopic Approach ◽

Single Centre ◽

Single Centre Experience ◽

Paediatric Liver Transplantation

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Editorial Comment on: Laparoscopic Approach for Urinary Sphincter Implantation in Women with Intrinsic Sphincter Deficiency Incontinence: A Single-Centre Preliminary Experience

European Urology ◽

10.1016/j.eururo.2009.03.046 ◽

2010 ◽

Vol 57 (3) ◽

pp. 504

Author(s):

Andrei Nadu

Keyword(s):

Editorial Comment ◽

Laparoscopic Approach ◽

Intrinsic Sphincter Deficiency ◽

Single Centre ◽

Urinary Sphincter ◽

Sphincter Deficiency

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Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x130624 ◽

2006 ◽

Vol 88 (6) ◽

pp. 566-570 ◽

Cited By ~ 26

Author(s):

MJ Forshaw ◽

JA Gossage ◽

J Stephens ◽

D Strauss ◽

AJ Botha ◽

...

Keyword(s):

Postoperative Morbidity ◽

Survival Rates ◽

Length Of Hospital Stay ◽

High Volume ◽

Cardiovascular Complications ◽

Pulmonary Complications ◽

Minimal Impact ◽

Cancer Services ◽

Clinically Significant ◽

Oesophagogastric Cancer

INTRODUCTION Oesophagogastric cancer surgery is increasingly being performed in only centralised units. The aim of the study was to examine surgical outcomes and service delivery within a specialist unit. PATIENTS AND METHODS The case notes of all patients undergoing attempted oesophagogastrectomy between January 2000 and May 2003 were identified from a prospective consultant database. RESULTS A total of 187 patients (median age, 63 years; range, 29–83 years; M:F ratio, 3.9:1) underwent attempted oesophagogastrectomy. Of these, 91% were seen within 2 weeks of referral and treatment was instituted after a mean of 31 days (range, 1–109 days). More patients underwent surgery (63%) than neoadjuvant therapy (56%) within 1 month of referral. The main indication for surgery was invasive malignancy in 166 patients (89%). The 30-day mortality was 0.5% (1 death) and in-hospital mortality was 1.1% (2 deaths). The median length of hospital stay was 14 days (range, 7–69 days). Significant postoperative morbidity included: pulmonary complications (36%), cardiovascular complications (16%), wound infection (13%) and clinically significant anastomotic leaks (7%). Of the study group, 28 patients (15%) were admitted to ICU with a median stay of 10 days (range, 1–44 days); this accounted for 0.9% of ICU bed availability. Twelve patients (6.4%) were returned to theatre, most commonly for bleeding. The 1-year survival rates were 78%. During 2002–2003, national waiting list targets for both hernia repair and cholecystectomy were achieved. CONCLUSIONS Despite recent increases in workload, high volume specialist units can deliver an efficient and timely service with both good treatment outcomes and minimal impact upon elective surgical waiting lists and ICU provision.

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