Background: Perioperative nutritional support is desirable in surgical patients with pancreatic disease who are often malnourished because of biliary and gastric outlet obstruction or the catabolic response to sepsis or cancer. This study reviewed the experience in providing enteral nutrition through a T-tube jejunostomy in these patients.

Methods: The records of a consecutive series of 36 patients (mean age 56 yr.) who had undergone pancreatic operations during the last four years were reviewed, and data were collected about their preoperative nutritional status and their postoperative feeding.

Results: Thirty-six patients had partially hydrolysed feeds administered through a feeding T-tube jejunostomy placed during pylorus-preserving proximal pancreatoduodenectomy (21), Whipple's procedure (4), debridement of infected pancreatic necrosis (3), palliative biliary and gastric bypass (2), distal pancreatectomy (2), cyst-jejunostomy (3) and accessory sphincteroplasty (1). Operations had been performed for benign (17) or malignant (19) disease of the pancreas. Tube feeding was employed for a mean of 18 days (range 1 - 60). There were no related deaths, but 8 patients had complications directly attributable to the tube including blockage (4), dislodgment (2), pericatheter leakage (2) and peritonitis in a patient with downstream adhesion obstruction. Twenty patients suffered complications that included transient diarrhoea (13), abdominal distension (8), nausea or vomiting (6) and pain (6). Consequently, nitrogen and energy needs were completely fulfilled in only 19 patients.

Conclusion: Providing nutrition by the enteral route can be a challenging exercise in pancreatic patients who typically have
two or more vulnerable upper intestinal anastomoses, bilio-pancreatic insufficiency and gastric stasis. Despite many minor
shortcomings, jejunostomy tube feeding appears to be a safe adjunct to pancreatic surgery.