Newsletter

[ Vol. 11 No. 2 ] (May - August 2010 )
Post gastrectomy early enteral feeding through naso-jejunal tube passed intraoperatively through anastomosis: Avoiding feeding jejunostomy

Joydeep Purkayastha
Department of Surgical Oncology, Nemcare Hospital, Guwahati, Assam, India

OBJECTIVE
Early post operative enteral nutrition improves outcome of major gastrointestinal surgery like Radical Gastrectomy. It is also cost effective compared to Parenteral nutrition. A method of early enteral feeding is presented in this study.

METHODS
A total of 2010 patients of Radical Gastrectomy and 72 patients of Palliative Gastro-jejunostomy procedures were taken up for early enteral feeding during the period from January 2003 to January 2009. During surgery, after completion of the posterior Gastrojejunostomy layer, the anesthetist passes a Ryle’s tube (No 14 Fr.) through the nostril. This tube is then made to pass through the anastomosis, by the surgeon, into the jejunum upto a distance of 50 cms from the anastomosis. Meanwhile another Ryle’s tube is also kept through the other nostril upto the remnant stomach for gastric aspiration. Feeding is started through the jejunal Ryle’s tube 24 hours after surgery. The gastric Ryle’s tube is removed after 4 to 5 days and oral feeding is started. The jejunal Ryle’s tube is removed once the patient is able to tolerate sufficient oral feeding.

RESULTS
Early jejunal feeding could be given successfully and was tolerated in all the 282 patients in whom it was attempted. Intravenous fluid could be stopped once feeding started. The jejunal Ryle’s tube could be removed within 7 to 10 days.

CONCLUSION
Intra-operative insertion of a Ryle’s tube into the jejunum through anastomosis of gastric surgical procedures could be a cheap and effective option for early post operative enteral feeding.

From  
PENSA 2009
“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 71