JejunostomyEdit

A jejunostomy is a surgical opening created into the jejunum, typically to place a feeding tube that delivers nutrition directly into the small intestine. The tube, often called a J-tube, can be placed through the abdominal wall and may be temporary or permanent. Jejunostomies are used when the stomach is unsuitable for feeding due to obstruction, impaired motility, or a high risk of aspiration, or after certain surgeries. They can be placed using different approaches, including surgical, laparoscopic, or percutaneous techniques, and they are part of the broader field of enteral nutrition, which aims to supply nutrients directly via the gastrointestinal tract when oral intake is not feasible. See Enteral nutrition and Jejunum for related concepts.

Historically, the idea of feeding directly into the intestines evolved alongside advances in surgical technique and anesthesia. Early jejunostomies were more invasive and carried substantial risk, but innovations in sterile technique, imaging, and minimally invasive methods have improved safety and reduced recovery times. In recent decades, techniques such as percutaneous endoscopic jejunostomy have become common, offering options that can be performed without a large open operation in many cases. See Percutaneous endoscopic jejunostomy for a related method and Laparoscopy for a minimally invasive approach.

Medical uses - Long-term enteral nutrition when the stomach cannot be used, whether due to obstruction, severe gastroparesis, prior surgeries, or recurrent reflux that raises aspiration risk. In such cases, delivering nutrients to the jejunum can help minimize regurgitation and protect the airway. See Gastrostomy with jejunal extension as an alternative approach. - Postoperative or disease-related temporary support during recovery from head and neck cancer treatment, esophageal surgery, or other conditions where gastric feeding is contraindicated or not tolerated. See Head and neck cancer and Esophageal surgery for context. - Decompression or access in certain small bowel conditions, though this is a less common indication than nutrition support.

Procedure and postoperative considerations - A jejunostomy tube is secured through the abdominal wall into the jejunum. Placement can be surgical, laparoscopic, or performed percutaneously under endoscopic guidance, depending on the patient’s anatomy and the clinical scenario. See Percutaneous endoscopic jejunostomy and Surgical procedure for broader methodological context. - After placement, nutrition is delivered via the tube through a dedicated feeding pump, with care taken to avoid infection at the skin entry site and to monitor for tube dislodgement, obstruction, or kinking. See Enteral feeding for general principles. - In certain patients, the stomach remains available for other uses, and a jejunostomy allows feeding beyond gastric issues while preserving overall digestive function.

Risks and complications - Local skin irritation or infection at the stoma site, tube failure or dislodgement, and blockage of the tube. More serious but less common risks include bowel perforation, peritonitis, and unwanted leakage. - Long-term implications can include nutritional deficiencies if feeds are not properly managed, and rarely the development of fistulas or adhesions. Regular monitoring with a healthcare team is standard practice, and patient selection aims to balance benefits with these risks. See Complications of feeding tubes for related considerations.

Alternatives and related procedures - Gastrostomy with a jejunal extension or enteroenteric feeding strategies may be used when overnight feeding is needed but a jejunostomy is not ideal. See Gastrostomy and Enteral feeding for related concepts. - Nasogastric or orogastric tubes provide less invasive, short-term support and are appropriate for temporary situations or diagnostic testing, but they are generally less suitable for long-term, reliable nutrition in patients at high risk of aspiration. See Nasogastric tube. - Parenteral nutrition, which supplies nutrients intravenously when the gut cannot be used, is an alternative in certain cases, though it carries its own risks and costs. See Parenteral nutrition. - In some cases, surgical decisions favor a combination approach or different routes depending on the patient’s overall health, goals, and setting of care.

Controversies and debates - Cost, access, and settings of care: Critics on the more conservative side of policy debates emphasize the importance of patient autonomy and cost-effectiveness, arguing that home-based enteral feeding and outpatient placement can reduce hospital stays and overall health expenditures. Proponents stress that proper selection, clear goals of care, and robust caregiver support are essential to avoid unnecessary use of technology. See Health care costs and Home health care for broader policy contexts. - Quality of life versus prolongation of life: In certain chronic or terminal conditions, debates arise about whether long-term jejunostomy feeding meaningfully improves quality of life or merely sustains biological function without improving day-to-day life. Supporters argue that for many patients and families, independence and the ability to avoid frequent hospital visits are valuable, while critics worry about overuse in cases where comfort and dignity might be better served by palliative approaches. See Quality of life and Palliative care for related discussions. - Patient selection and informed consent: In health systems with mixed public and private funding, reasonable people can disagree about who should qualify for a jejunostomy and on what grounds. Advocates emphasize informed consent, realistic goals, and ongoing reassessment, while critics worry about incentives that might favor longer treatment courses at higher cost. This tension is common across enteral feeding decisions and reflects broader policy debates about how to allocate scarce resources. See Informed consent.

See also - Enteral nutrition - Gastrostomy - Nasogastric tube - Parenteral nutrition - Percutaneous endoscopic jejunostomy - Jejunum - Head and neck cancer - Esophageal surgery