Jejunostomy feeding tube – open (Witzel procedure)



Indications

Inability to use the mouth, stomach, or esophagus for feeding due to dysfunction

Loss of brain function secondary to head trauma or cerebrovascular accident.

Steps in the Procedure

1. The patient is placed supine (face up) on the operating room table

2. A #10 scalpel is used to make a midline incision

3. Dissection is done through the subcutaneous tissues using Bovie cautery.

4. The midline between the layers of the rectus muscle is identified.

5. The anterior fascia is incised using a Metzenbaum scissors or scalpel.

6. The preperitoneal fat is identified and grasped between two DeBakey forceps.

7. The peritoneum is identified and incised using the Metzenbaum scissors, thus allowing entry into the abdomen.

8. The forefinger or a right-angle clamp is placed into the peritoneal cavity and then retracted upwards.

9. Bovie cautery is used to open the peritoneal cavity cephalad (toward the head) and caudally (toward the feet).

10. An abdominal wall retractor such as a Balfour or Bookwalter is placed if needed to increase exposure.

11. The small bowel is traced proximally (toward the head) until the ligament of Treitz marking the juncture between the duodenum and the jejunum is located.

12. Approximately 30 cm is measured from the ligament of Treitz for optimal placement of the enterostomy (entry site in the jejunum where the tube is placed.)

13. The loop of small bowel where the entry is to be grasped between the thumb and forefinger of both hands of the first assistant.

Written by