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4.4.2 Materials and Equipment
A small long bore feeding is used for a jejunostomy tube. Usually tube from 5 to 9 Fr are used (Figure 4.8). The tubes are 50–89 cm long.
General anesthesia is required for the placement of a jejunostomy tube.
4.4.3 Technique
4.4.3.1 Laparoscopically Assisted
Three separate cannulas are used. One cannula is placed where the jejunostomy tube is placed in the right side of the abdominal cavity (Figure 4.9). A single‐access port can also be used and it is inserted in the middle of the right side of the abdominal cavity. The port is placed lateral to the rectus abdominalis muscle.
After insufflation of the abdominal cavity a 5 mm rigid endoscope and two 5 mm grasping forceps are used to visualize and manipulate the loop of jejunum. After identifying the most proximal loop of jejunum it is brought against the abdominal wall and the single‐access port is removed (Figure 4.9a). The oral and aboral orientation of the loop of jejunum should be identified. A stay suture is placed in the wall of the jejunum. A 4‐0 monofilament absorbable suture is then used to place a purse‐string suture in the wall of the jejunum (Figure 4.9b). A #11 blade is used to puncture the center of the purse‐string suture. The jejunostomy tube is then introduced in the lumen of the jejunum in the aboral direction (Figure 4.9c). Usually 15–20 cm of the tube is placed in the jejunum. The purse‐string suture is tightened around the tube. Four pexy sutures are placed between the wall of the jejunum and the transverse abdominalis muscle (Figure 4.9d and e). A 4‐0 monofilament absorbable suture is used for the pexy. The subcutaneous tissue and skin are closed in a routine fashion around the tube (Figure 4.9f and g).
4.4.3.2 Laparotomy
Jejunostomy tubes are frequently placed during a laparotomy. During laparotomy the tubes are placed either very proximal in the jejunum or distal to a surgical site to bypass it.
A #11 blade is then used to penetrate the abdominal wall from the skin surface on the right or left side of the abdominal cavity. The blade is introduced in the middle of the abdominal wall lateral to the rectus abdominalis muscle. A mosquito forceps grabs the blade in the abdominal cavity. The blade is withdrawn from the abdominal wall with the forceps. The forceps then grabs the feeding tube and pulls inside the abdominal cavity (Figure 4.10a).
A purse‐string suture with 4‐0 monofilament absorbable suture is placed in the wall of the jejunum.
A puncture is made in the center of the purse‐string in the wall of the jejunum (Figure 4.10b). The jejunostomy tube is then introduced in the lumen of the jejunum in the aboral direction. The tube is advanced over 20 cm and the purse‐string is tightened (Figure 4.10c). Four pexy sutures are placed between the wall of the jejunum and the transverse abdominalis muscle around the jejunostomy tube (Figure 4.10d and e). A 4‐0 monofilament absorbable suture is used for the pexy sutures. A finger‐trap suture with 3‐0 nylon is placed on the skin to secure the tube (Figure 4.10f).
The laparotomy is closed in a routine fashion.
4.4.4 Tips
An 8 Fr feeding tube can be used in cats as well as in small breed dogs. The larger tube will have less change to get occluded. It is important to flush the tube regularly.
The author has not been created a tunnel between the sero‐muscularis and the submucosa to place the jejunostomy tube.
A interlock box suture technique has been described to pexy the jejunum to the abdominal wall (Daye et al. 1999).
4.4.5 Utilization
A jejunostomy feeding tube can be used immediately even if the patient is heavily sedated. A liquid diet is required. After calculating the daily requirement the diet is delivery over 24 hours with a pump. The tube can be removed four days after its implantation.
An esophagojejunostomy tube can be placed also if an abdominal surgery is not indicated or possible (Cummings and Daley 2014).
4.4.6 Complications
Complications with jejunostomy tube are not frequent. The most common problem is obstruction of the tube. Also if the concentration of the liquid diet is too high it might induce diarrhea. Usually it is recommended to start with 1/4 to 1/3 of the daily maintenance and increase by 1/4 or 1/3 every day the amount of feeding.
4.5 Gastrojejunostomy Tube
4.5.1 Indications
The combination of a jejunostomy tube and gastrostomy tube is very common during the surgical treatment to septic peritonitis and during the reconstruction of the upper gastrointestinal tract (Cavanaugh et al. 2008). The jejunostomy tube is used first to support the patient while vomiting is occurring or the patient is lateral recumbent. The gastrostomy tube is used first to keep the stomach decompressed in an attempt to minimize gastroesophageal reflux, vomiting, and aspiration pneumonia. The gastrostomy is used later to provide more long‐term support to the patient when the vomiting episodes have subsided.
Instead of placing two separate
