Jejunostomy

Jejunostomy is a surgery in which a surgeon creates a small hole (stoma) inside the middle portion of the small intestine (jejunum) through the abdomen and inserts a delicate plastic tube (known as the jejunostomy tube or J-tube) into it.

The tube is stitched into the stoma on the abdominal skin to ensure that it does not move much. It is needed to fulfil your body’s nutritional requirements if you are unable to eat or drink normally for over seven days. Sometimes, a J-tube can also be used as an additional route to provide enough calories and nutrients required for a person.

Your healthcare practitioner may perform this surgery if you have one of the following conditions:

• Feeding by mouth is not possible 
• Before surgeries that can cause temporary loss of appetite or swallowing problem
• Surgeries involving the organs of the digestive system 
• Moderate to serious forms of malnourishment
• Cancer 
• Organ transplant (of the organs located in the abdominal region)
• A weakened or compromised immune system 
• After pancreatitis surgery

You cannot have this surgery if you have the following conditions:

• Obstruction or swelling in the intestines
• Crohn’s disease (swelling in the digestive tract, which leads to pain)
• Coagulopathies (disorders with impaired clotting of blood)
• Post-radiation enteritis (swelling/inflammation in the intestines)
• Ascites (gathering of fluid in the abdominal region)

Before the surgery, you will need the following preparations:

• Medicines: 

  • You should provide information to your doctor about all the medicines that you are taking (previous or current). This includes prescribed, non-prescribed and herbal medicines and supplements.
  • Your doctor will ask you to stop the intake of blood-thinning medicines such as warfarin, heparin or clopidogrel for some time before and after the surgery.
  • If you are taking medicine for diabetes or insulin, it's dosage will be changed/adjusted before the surgery.
  • You will be asked to bring all the medicines (including supplements and ointments) instructed/prescribed by your doctor on the day of your surgery.
• Fasting:
  • You will need to fast from midnight before the day of surgery until after the surgery as per your doctor’s instructions.
  • You will be allowed to drink water until two hours before the surgery.
• Driving:
  • You will be needing someone (a friend or family member) to drive you home after your discharge from the hospital.
• Lifestyle:
  • You must apprise your doctor if you have allergies to anything including medicines used for anaesthesia.
  • You need to inform the doctor if you have any implanted device inside your body.
  • The doctor will ask you to quit smoking or drinking before the surgery until you recover.
• Consent:
  • You will have to grant your approval for the surgery by signing a consent form.

The surgeon with his/her medical team will perform this surgery in the following way:

• You will have to complete all pre-surgical formalities and wear hospital clothes. After this, the surgical team will ask you to lie down on the operating table.
• The healthcare provider will monitor your vitals such as breathing, heart rate and blood pressure to ensure your suitability for the surgery. 
• You will be provided oxygen through the nose. 
• A mouthguard will be placed over your teeth to protect them. 
• You will be given anaesthesia (medicine to make you sleep/relax) through your vein. 
• Once you are unconscious/asleep, the surgeon will introduce an endoscope (a tube-like device with a camera) into your jejunum through your mouth to examine your small intestine. 
• Thereafter, he/she will make a cut/incision in your abdomen extending into the jejunum. 
• Next, the surgeon will put in the feeding tube through the incision and place stitches to fix the tube in position with the abdominal skin. 
• A small part of the tube will come out of the body from the stoma (newly created opening via surgery). 
• The surgeon will then cover the stoma with dressing and take out the endoscope.

Post-surgery, you will be moved to a care unit, where your heart rate, breathing, blood pressure and temperature will be monitored to carefully assess your recovery. The doctor will show you how to feed yourself through the tube before leaving the hospital.

Once you are home, you will need to take the following care:

• Medicines and health condition:

  • You may have a sore throat for a few days after the surgery, which will automatically heal. 
  • You may experience some uneasiness for up to two days after the surgery at the surgical site. 
  • If you are experiencing pain, the doctor may prescribe pain medicines after the surgery. 
• Care for the skin near the J-tube:
  • You should keep the skin clean and dry. 
  • Wash your hands with soap (sanitizer) and water before changing the dressing/bandage. 
  • Avoid rotating the tube as it can cause blockage. 
  • A minimal amount of green or yellow discharge from the skin around the tube or surgical site is normal.
  • If you experience leakage, then you can place a small gauze under the disc surrounding the tube. 
• Bathing:
  • Your doctor may allow taking a shower two days after the surgery. 
  • You must avoid the use of bathtubs or swimming for at least two weeks after the surgery. 
  • You should remove the previous dressing before taking a shower.
  • Clean the surgical area with soap (or sanitizer) and water for at least 20 seconds then pat the wound delicately to dry it. 
• Changing the dressing: While changing the dressing, the following instructions should be adhered to:
  • Remove the old dressing/bandages.
  • Cleanse the surgical area with iodine swab for at least once a day.
  • Apply zinc oxide ointment and gently put gauze on the surgical site.
  • Coil the tube around the abdominal skin and fix with a tape.
• Flushing the tube: The instructions for flushing the tube are provided below:
  • Wash your hands with soap (or sanitiser) and water.
  • Take 60-ml water in a disposable syringe.
  • Put a paper towel below the edge of the tube to soak up the drainage.
  • Clamp (press it close with a clamp) the tube. - the clamp of the jejunostomy tube is to keep fluids from coming out of the tube
  • Put the syringe in the end of the tube.
  • Inject water inside the tube by opening it.
  • Again, clamp the tube.
  • Remove the syringe.

Food habits: For five days after the surgery, you will not be allowed to eat or drink by mouth. When you are discharged to home, you may be asked to take food by mouth as well as through the tube. You will be asked to begin with a liquid diet first and then gradually add more solids to your diet. You may need to continue using the tube until you are able to nourish yourself adequately by mouth.

You should eat soft foods and foods that are easy to eat when you begin on solid foods.

When to see the doctor?

If you experience the following symptoms after the surgery, you should see your doctor:[8]

• Dizziness 
• Weakness 
• Fever 
• Chest pain 
• Diarrhoea 
• Bleeding 
• Trouble flushing the tube 
• Redness, soreness or pus near the surgical site 
• Excessive drainage from the site of operation
• Severe abdominal pain 

The possible risks of this surgery are as follows:

• Infection 
• Organ puncture 
• Incorrect placement of the tube 
• Granulation of tissue (redness or soreness around the skin)
• Bleeding 
• Intussusception (folding of one part of intestine on another causing obstruction/blockage)

You will need a follow-up visit with your doctor to determine how long the tube should be placed inside the abdomen. Usually, a visit will be scheduled four to six weeks after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.