Role of feeding jejunostomy in patients undergoing pancreatoduodenectomy: a single center experience

Background: Concomitant placement of Feeding Jejunostomy (FJ) tubes is common after pancreaticoduodenectomy for optimizing postoperative nutrition. The aim of this study is to determine the role FJ tube placement for postoperative nutrition following pancreaticoduodenectomy.Methods: All patients undergoing concomitant FJ following pancreaticoduodenectomy (Whipples procedure) from July 2014 to July 2016 were reviewed retrospectively. FJ feeds were routinely started on POD 2. Jejunostomy feeds were discontinued once patient is able to take adequate oral feeds. Data were represented by frequency and mean.Results: A total of 28 patients underwent pancreaticoduodenectomy in the study period and concomitant FJ was performed in all those patients. A total of 18 (64.3%) were men and mean age was 47.1 years. Majority (25, 89.3%) of these patients had malignancy as an indication for surgery. Only 6 out of 28 (21.4%) patients required nutrition supplementation through FJ on POD 7. Only 2 out of 28 (7.1%) patients required FJ feeds on POD 30. None of these patients had tube related complications in 30-day postoperative period. There was no FJ related mortality in 30-day postoperative period. The patients who required prolonged FJ feeds had grade C pancreatic leak, gastrojejunal anastamotic leak and GJ anastamotic stricture.Conclusions: Concomitant FJ can be used as a routine in patients undergoing pancreaticoduodenectomy. It is especially beneficial among patients requiring prolonged postoperative nutritional supplementation due to grade c pancreatic leak and gastrojejunal anastamotic leak. Literature review suggested that one third of the nasojejunostomy tubes dislodge and TPN doubles the risk of infection, hence FJ is considered safe and effective adjunct for patients undergoing pancreaticoduodenectomy.