WANG Pu , LIU Yongzhi , LI Genshui , CHEN Daqing , GUO Kunliang , WANG Huan , WANG Xiao , CHEN Jian
  • Department of Cardiothoracic Surgery, Anqing Municipal Hospital, Anqing, 246003, Anhui, P. R. China;
CHEN Jian, Email: 423287497@qq.com
Esophageal cancer; thoracoscopic surgery; Ivor-Lewis; jejunostomy; complication
10.7507/1007-4848.202406040
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Objective  To evaluate the application effect of modified jejunostomy in thoracoscopic Ivor-Lewis esophagectomy. Methods  A retrospective analysis of patients who underwent Ivor-Lewis esophagectomy for middle and lower esophageal cancer from 2017 to 2023 in our department was performed. The patients from 2017 to 2020 receiving "C+I" in the upper jejunum according to the "C+I" model, and fistula fixed with only two purse-string sutures and the abdominal wall were allocated into a group A. The patients from 2021 to 2023, on the basis of "C+I" suture, the jejunum and abdominal wall fixed with 3-0 absorbable thread for 1-2 needles at the proximal or distal end of the fistula 10-15 mm, and the upper jejunum and abdominal wall fixed into "curtain" were allocated into a group B. The operation time, jejunostomy time, postoperative pathological stage, and enteral nutrition-related complications such as the incidence of incomplete intestinal obstruction, closed loop intestinal obstruction and intestinal volvulus requiring secondary surgery, skin redness and swelling of intestinal fluid leakage, stoma tube blockage, and accidental extubation were compared between the two groups. Results  All patients successfully completed Ivor-Lewis esophagectomy under thoracoscopy. There was no perioperative death. There were 118 patients in the group A, including 72 males and 46 females, with an average age of 64.58±6.30 years. There were 125 patients in the group B, including 76 males and 49 females, with an average age of 65.11±6.81 years. There was no statistical difference in operation time, jejunal fistula time, fistula blockage or accidental extubation rate between the two groups (P>0.05). There was a statistical difference in the incidence of incomplete intestinal obstruction (P=0.035), and closed loop intestinal obstruction requiring secondary surgery (P=0.017). There were 36 patients of eczema-like changes in the patients with severe intestinal leakage and redness in the group A, and 7 patients of intestinal leakage and redness in the group B (P<0.001). Conclusion  The modified jejunostomy can significantly reduce the incomplete intestinal obstruction, closed loop intestinal obstruction and secondary operation rate after "C+I" jejunostomy, and significantly improve the leakage of intestinal fluid at the stoma and the injury of surrounding skin and soft tissue. Improvements in certain technologies reduce operational difficulties and is worthy of promotion and application in clinical practice.