Feeding the gut after revisional bariatric surgery: The fate of 126 enteral access tubes

Background: Revisional bariatric surgery (RBS) is associated with higher complication rates compared with primary bariatric surgery. Feeding tubes (FTs), including gastrostomy and jejunostomy tubes placed during RBS, may serve as a safety net to provide nutrition when oral intake is contraindicated or limited; however, FTs in this setting have not been well investigated. Objectives: This study aims to determine complications, use, and duration of FTs placed during RBS. Setting: A high-volume academic medical center in the United States. Methods: Included patients underwent RBS between January 2008 and December 2016 with FTs placed at the time of RBS. Results: There were 126 patients identified (84.9% female, 76.2% Caucasian, mean age 53.4 +/- 10.9 yr). Patients had previously undergone Roux-en-Y gastric bypass (34.1%), vertical banded gastroplasty (27.8%), and adjustable gastric band (14.3%). Indications for RBS included correction of complication of prior bariatric surgeries (50%), weight regain/failure to lose weight (32.3%), or both (17.3%). Most FTs were placed in the excluded stomach (89.7%), and median tube size was 18 F. FTs were used for feeding in 68.2% of patients, with feeding initiated in a median of 2 days. Leakage around the tube (32.5%) and pain (26.8%) were common complaints. Significant tube related complications included infection (9.1%), dislodgement (5.9%), reintervention (5.8%), and reoperation (2.8%); 16.7% experienced at least 1 significant complication. FTs were removed at a median of 36 days. Conclusion: FTs may aid in prevention of perioperative dehydration and malnutrition after RBS, but should not be considered a benign intervention. FT use should be balanced against institutional outcomes and care goals. (C) 2018 American Society for Metabolic and Bariatric Surgery. All rights reserved.