Feeding catheter gastrostomy at esophagectomy with gastric tube reconstruction through posterior mediastinal route

We introduce our novel and original idea of placing a feeding catheter gastrostomy (FCG) at esophagectomy with gastric tube reconstruction through the posterior mediastinal route. The 9-Fr catheter was inserted into the jejunum through the gastric tube by the creation of submucosal and Witzel tunnels on the gastric antrum. Among the 45 patients who underwent FCG, the catheter was guided to the anterior abdominal wall through the sub-diaphragm route in 25 patients (group A) or the extra-peritoneal route with the overlapping of catheter entry by the omentum in 20 patients (group B). There were no cases of spontaneous catheter prolapse or bowel obstruction. Five out of 45 patients (11.1%), including 4 (16%) in group A and 1 (5%) in group B, showed mild and transient localized peritonitis after catheter removal. The extra-peritoneal route with omental cover is recommended for safe indwelling catheterization. FCG is useful for avoiding jejunostomy-related bowel obstruction.