Details

Autor(en) / Beteiligte

• Zapas, John L.
• Karakozis, Stavros
• Kirkpatrick, John R.

Titel

Prophylactic jejunostomy: A reappraisal

Ist Teil von

• Surgery, 1998-10, Vol.124 (4), p.715-720

Ort / Verlag

United States: Mosby, Inc

Erscheinungsjahr

1998

Quelle

ScienceDirect

Beschreibungen/Notizen

• Background: The effectiveness of enteral feeding in maintaining postoperative nutrition has led some investigators to recommend prophylactic jejunostomy at the time of any high-risk abdominal operation. A failed procedure in this setting weighs heavily on the side of risk without identifiable benefit. Methods: A benefit/risk analysis comparing complication rate, avoidance of parenteral nutrition, and discontinuation of jejunostomy feeding was performed in 92 patients. These patients were judged retrospectively to be undergoing either a prophylactic jejunostomy placed at the time of operation for another serious condition (group A) or therapeutic jejunostomy alone (group B) during a 3-year period (1993 to 1996). Classification as prophylactic or therapeutic was determined by the surgeon's preoperative intent. Results: Avoidance of parenteral nutritional support, a goal of prophylactic jejunostomy, was not achieved in 39% of the patients. Patients in group A had a 5-fold increase in the risk of premature discontinuation of enteral feeds when compared with group B (P <.03). The complication rate was higher in group A (41%) than in group B (26%). Four life-threatening complications occurred in group A; all required reversal of the feeding jejunostomy. Conclusions: This study suggests that the benefit/risk ratio of prophylactic jejunostomy is low. This adds weight to the notion that this procedure be abandoned in favor of other forms of nutritional support. (Surgery 1998;124:715-20.)