The “omega” jejunostomy tube: A preferred alternative for postpyloric feeding access

AimWe present our technique for construction of the “Omega Jejunostomy” (OJ), a novel method of postpyloric feeding using a pouched-jejunal loop capable of accommodating a balloon gastrostomy button. We describe potential indications for the procedure and outcomes in a complex patient population.Materials and methodsWe retrospectively reviewed records of patients who underwent an OJ at our institution between 2005 and 2014. Primary outcomes include operating time, length of hospital stay, time to feeding goals, and postoperative complications.ResultsWe identified 12 children (6 males) with multiple comorbidities who underwent OJ procedures. The median age at surgery was 11 years (range 3 months–23 years). Eleven patients had failed previous alternative feeding access or antireflux procedures. All patients eventually reached their feeding goals. Eight were at goal feeds in < 10 days. Two achieved goal feeds < 1 month, one < 4 months, and one within 7 months. There was one OJ failure because of fistula formation requiring surgical revision, and one child was treated successfully but died of unrelated causes. Four children eventually transitioned to PO or G-tube feeds, and six were tolerating feeds via OJ at last follow-up (8–74 months).ConclusionsOJ provides a durable alternative to gastrojejunostomy tube for patients who are poor candidates for or have failed Nissen fundoplication. It is technically easier to perform than a gastroesophageal disconnect procedure, has minimal surgical comorbidities, and can provide durable feeding access and achievement of goal feeds in a complex and refractory patient subset.