Management of the surgical solutions for feeding – a prevention factor for nutrient balance impairment

Aim. The paper aims, thanks to the long-standing practice, to synthesize the clinical experience gained during the surgery for feeding tubes management and highlight the details we had to deal with in order to overcome the local and general difficulties. Materials and method. A retrospective study was carried out over a period of 20 years (1996-2016), on the patients who underwent surgery for placing feeding tubes in our clinic. They were analyzed: the techniques used, the long-term evolution, the complications and the incidents and the way they were solved. Results. A total of 329 patients were enrolled in the study. The surgical techniques used were: classic surgical solutions (300 cases) and percutaneous endoscopic gatrostomy (PEG, 29 cases). For classical interventions, post-operative evolution was good in 219 patients (73%) and was complicated by various accidents and incidents in 81 cases (23%). The study presents the causes that may lead to these complications, the local and general, clinical and paraclinical consequences and the correct surgical attitude, as well as particular cases that required the adaptation of the surgical techniques to local anatomical and functional polymorphism. In the long run, the jejunostomy appears to be relatively inferior to gastrostomy, in terms of tolerance and efficiency. PEG complications were minor and transient, but the reduced number of cases and the limited period of postoperative surveillance did not allow statistically significant conclusions to be drawn. Conclusions. The postoperative management of surgical feeding solutions requires permanent collaboration between surgeon, patient and outpatient nursing services at home and requires knowing and observing of a specific nursing protocol to avoid disturbing the nutrient balance of the patient.