Comparison of laparoscopic and open stand-alone feeding jejunostomy in patients with proximal gastrointestinal tract malignancies: An open-label randomised controlled trial.

INTRODUCTION

Patients with obstructive upper gastrointestinal malignancies often suffer from severe dysphagia and cachexia, necessitating enteral feeding. While open feeding jejunostomy (OFJ) is the traditional approach, laparoscopic feeding jejunostomy (LFJ) offers a minimally invasive alternative. This study aimed to compare the safety and outcomes of LFJ versus OFJ.

PATIENTS AND

METHODS

A prospective, randomised controlled trial was conducted at a tertiary care centre in South India from April 2022 to June 2023. Patients with obstructive upper gastrointestinal cancers were randomised to undergo LFJ or OFJ. The primary endpoint was the incidence of early major complications (Clavien-Dindo grade ≥3). The secondary endpoints included operative time, intraoperative complications, post-operative pain, time to initiate and reach full-strength jejunal feeding, hospital stay and minor complications (Clavien-Dindo grade ≤2). Patients were followed for 30 days postoperatively.

RESULTS

Fifty-nine patients met the inclusion criteria (30 LFJ, 29 OFJ). Baseline characteristics were similar, except for a higher rate of comorbidities in the OFJ group. The incidence of major complications was not significantly different (LFJ 10% vs. OFJ 17%, P = 0.472). LFJ was associated with significantly fewer minor complications (26.6% vs. 89.6%, P < 0.001), reduced post-operative pain, earlier initiation of feeds and shorter hospital stay. Operative time was longer in the LFJ group (100.4 ± 12.5 vs. 59.2 ± 6.9 min, P < 0.001).

CONCLUSIONS

LFJ is a safe and effective alternative to OFJ, offering better post-operative recovery despite a longer operative time and is recommended in appropriate candidates.