Laparoscopic Jejunostomy

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Essential equipment:
    Two 5mm (midline epigastrium and hypochondrium) 
    One 12mm umbilical trocars 
    Two 5mm fenestrated De’Bakey grasping forceps 
    5mm needle holder 
    MIC Jejunostomy tube

Using two atraumatic graspers, the jejunum is run to the ligament of Trietz. Once identified, it is run forward 30cm.  A location for the jejunostomy is identified and marked. The surgeon should simultaneously chose the entry site of the jejunostomy tube on the abdominal wall ( preferably in the left upper quadrant).

Inserted an angled 5mm trocar at the location chosen for the jejunostomy on the anterior abdominal wall.  Insert a grasper via the lower midline 5mm trocar into this newly inserted port.  The latter trocar is then removed over this dissecting instrument.  The distal end of the Jejunostomy tube is then grasped outside the intra-abdominal cavity and pulled into the intra-abdominal cavity. The Dacron ring is positioned at the level of the abdominal fascia. The jejunostomy tube is now clamped to maintain the pneumoperitoneum.

grasp the Jejunum with an atraumatic grasper proximal to the site of the enterotomy.  Make a 3mm enterotomy is on the antimesenteric border. The tip of the jejunostomy tube is then inserted into the lumen.   Do not construct a submucosal tunnel.  Ensure that the distal wings of the catheter are inserted into the lumen (secure the catheter when deployed in intraluminaly).  It may take a bit of force.

Insert a purse string suture around the jejunal insertion site.

The purse string suture is tied and then sutured on the anterior abdominal wall, 3 cm inferior to the entry site of the jejunostomy catheter.  Two additional sutures are placed to further secure the catheter onto the abdominal wall.

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SPIRE Hospital, Bristol. 
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