44186 Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding)

Name of the Procedure:

Laparoscopy, surgical; jejunostomy (e.g., for decompression or feeding)

Summary

A laparoscopy jejunostomy is a minimally invasive surgical procedure where a feeding tube is placed directly into the jejunum (part of the small intestine) through small incisions in the abdomen. This allows for direct nutrition delivery or gastrointestinal decompression.

Purpose

The procedure addresses conditions where oral intake is insufficient, impossible, or undesirable due to medical issues. It aims to provide an alternative nutrition route or decompress the intestine to relieve symptoms.

Indications

• Severe malnutrition or inability to consume food orally
• Chronic gastrointestinal obstruction
• Persistent vomiting or gastric stasis
• Certain cancers or surgeries impacting digestive function
• Severe dysphagia (difficulty swallowing)

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Possible adjustments of medications, especially anticoagulants.
• Blood tests, imaging studies, and health assessments to evaluate the patient’s overall condition.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incisions: Small incisions are made in the abdominal wall.
3. Laparoscope Insertion: A laparoscope (a thin, lighted tube with a camera) is inserted to visualize the abdominal cavity.
4. Tube Placement: Additional small instruments are used to place the feeding tube into the jejunum.
5. Securing the Tube: The tube is secured in place to prevent dislodgment and properly positioned for feeding.
6. Closure: Incisions are closed with sutures or surgical tape.

Duration

Typically takes about 1 to 2 hours.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• General surgeon or gastrointestinal surgeon
• Anesthesiologist
• Surgical nurses
• Assistive surgical staff

Risks and Complications

• Infection at the incision or tube site
• Bleeding
• Injury to surrounding organs
• Tube dislodgment or blockage
• Anesthesia-related complications
• Gastrointestinal complications, such as leakage or perforation

Benefits

• Provides necessary nutrition when oral intake is not possible
• Can relieve symptoms of gastrointestinal obstruction
• Improves overall quality of life and nutritional status
• Benefits can be realized within a few days to a week

Recovery

• Post-procedure monitoring for a day or two in the hospital
• Pain management as necessary
• Gradual introduction of nutrition through the tube
• Instructions on tube care and maintenance
• Typical recovery period ranges from one to two weeks
• Follow-up appointments to ensure proper healing and tube function

Alternatives

• Percutaneous endoscopic gastrostomy (PEG) tube
• Nasogastric (NG) tube feeding
• Total parenteral nutrition (TPN)
• Each alternative has its own risks and benefits; for example, TPN avoids the gastrointestinal tract entirely but can cause complications related to intravenous nutrition.

Patient Experience

• During the procedure: Under general anesthesia, no sensations are felt.
• After the procedure: Initial discomfort or pain at the incision sites, managed with pain relief measures.
• Mild restrictions on activities for a few weeks.
• Detailed instructions on feeding and tube care to promote comfort and prevent complications.