Objective—To evaluate the use of laparoscopic-assistedjejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement.
Animals—15 healthy mixed-breed dogs.
Procedures—Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O2 delivery were calculated.
Results—All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O2 delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were foundbetween groups undergoing laparoscopic-assistedandopen surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs.
Conclusions and Clinical Relevance—Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.
Objective—To evaluate feasibility of performing
laparoscopic-assisted placement of a jejunostomy
feeding tube (J-tube) and compare complications
associated with placement, short-term feedings, and
medium-term healing with surgically placed tubes in
Animals—15 healthy mixed-breed dogs.
Procedure—Dogs were randomly allocated to
undergo open surgical or laparoscopic-assisted J-tube
placement. Required nutrients were administered by
a combination of enteric and oral feeding while monitoring
for complications. Radiographic contrast studies
documented tube direction and location, altered
motility, or evidence of stricture.
Results—Jejunostomy tubes were successfully
placed in the correct location and direction in all dogs.
In the laparoscopic group, the ileum was initially
selected in 2 dogs, 2 dogs developed moderate hemorrhage
at a portal site, and 2 J-tubes kinked during
placement but were successfully readjusted postoperatively.
All dogs tolerated postoperative feedings.
All dogs developed minor ostomy site inflammation,
and 1 dog developed bile-induced dermatitis at the
ostomy site. Despite mild, transient neutrophilia, no
significant difference was noted in WBC counts
between groups. No dog had altered gastric motility
or evidence of stricture, although the jejunopexy site
remained identifiable in several dogs at 30 days.
Conclusions and Clinical Relevance—Requirements
for successful J-tube placement were met by use of a
laparoscopic-assisted technique, and postoperative
complications were mild and comparable to those
seen with surgical placement. Laparoscopic-assisted
J-tube placement compares favorably to surgical
placement in healthy dogs and should be considered
as an option for dogs requiring enterostomy feeding
but not requiring a celiotomy for other reasons. (J Am
Vet Med Assoc 2004;225:65–71)