# Laparoscopic round‑ligament duodenostomy synchronized with posterior mediastinal reconstruction

## TL;DR

A new laparoscopic technique for duodenostomy during esophagectomy may improve recovery by enabling earlier feeding and reducing complications.

## Contribution

The study introduces a fully laparoscopic duodenostomy technique using the round ligament for enteral access during esophagectomy.

## Key findings

- Laparoscopic duodenostomy allowed earlier initiation of enteral feeding compared to minilaparotomy.
- Laparoscopic procedures had no tube-related infections, while 18.2% of minilaparotomy cases did.
- Noninfectious complications were low in both groups, with no significant difference.

## Abstract

Esophagectomy is a highly invasive procedure, and early enteral nutrition supports recovery. Feeding jejunostomy is common but may cause fixation-related mechanical complications. To address these issues, a duodenostomy using the hepatic round ligament was adapted to a fully laparoscopic approach.

We aimed to evaluate the feasibility and short-term outcomes of laparoscopic duodenostomy using the round ligament as enteral access during esophagectomy.

We retrospectively reviewed 26 consecutive patients who underwent esophagectomy with duodenostomy at a single institution: 15 by a standardized laparoscopic technique and 11 by historical minilaparotomy. The laparoscopic method routes a catheter through a round-ligament sleeve, with double purse-string fixation at the duodenal bulb and 3-point anchoring at the intestinal and abdominal wall sites. The primary outcomes were feasibility and timing of enteral feeding initiation. A tube-related infection was defined as local redness, swelling, purulent discharge, or abscess along the catheter tract or exit site, consistent with the Centers for Disease Control and Prevention criteria. Noninfectious tube-related complications included dislodgement, inversion, or obstruction due to kinking. Differences between the groups are presented descriptively.

All laparoscopic procedures achieved successful catheter placement. Enteral feeding began earlier after laparoscopy (median [interquartile range] postoperative day, 1 [1–2]) than minilaparotomy (2 [2–6]). Tube-related infection occurred in 0 of 15 laparoscopy procedures and 2 of 11 (18.2%) minilaparotomies, and noninfectious tube-related complications occurred in 1 of 15 patients (6.7%) from the former group and 1 of 11 (9.1%) from the latter.

In this small, single-center, retrospective, exploratory series, laparoscopic round-ligament duodenostomy was feasible and coherent with minimally-invasive esophagectomy, and may facilitate earlier enteral access while reducing fixation-related problems; these findings require confirmation in larger prospective studies.