Feeding Duodenostomy Tube Placement After Minimally Invasive Esophagectomy with Posterior Mediastinal Reconstruction.

BACKGROUND: Early enteral nutrition is crucial for postoperative recovery after esophagectomy. A jejunostomy is conventionally created for nutritional access, but severe postoperative complications such as intestinal obstruction and intestinal torsion have been reported. This retrospective study evaluated the safety and feasibility of feeding duodenostomy tube placement utilizing the round ligament of the liver. METHODS: Patients who underwent esophagectomy with posterior mediastinal gastric conduit reconstruction and feeding duodenostomy at Kyoto University Hospital between October 2022 and February 2026 were included. Duodenostomy involved inserting a catheter into the duodenal bulb, securing it with the Stamm technique, then covering it with the hepatic round ligament. The primary outcome was short- and long-term incidence of catheter-related complications. RESULTS: Duodenostomy was performed in 102 patients. No intraoperative or in-hospital catheter-related complications (i.e., intestinal obstruction, torsion, or peritonitis) or in-hospital mortality were observed. Most catheters (91.5%) were successfully removed electively on an outpatient basis. During follow-up, one patient (1.0%) experienced late intestinal obstruction, which resolved conservatively. Three patients (2.9%) experienced catheter-related intra-abdominal infectious complications, all of which were successfully managed with antibiotic therapy. CONCLUSIONS: Feeding duodenostomy utilizing the round ligament of the liver is a safe and feasible method for enteral nutrition post-esophagectomy, even among patients undergoing posterior mediastinal gastric conduit reconstruction. This technique can significantly reduce the risk of postoperative intestinal obstruction and improve postoperative management.