The ENDOSTITCH* instrument is inserted via the lower midline trocar.
The ENDOSTITCH* is loaded with a 7 inch, 2.0 SOFSILK** suture. A purse
string suture is inserted/sewn around the insertion site of the catheter
into the jejunum using the ENDOSTITCH* instrument. The suturing should
always be started anteriorly. At one point, the ENDOSTITCH* Instrument's
Needle will have to be passed from one side of the catheter to the other
side. This is done by closing the ENDOSTITCH* instrument around the
catheter (the catheter is between the jaws of the ENDOSTITCH* instrument -
refer to picture). Once this is done, the needle can be passed to the
other side of the catheter to complete the purse string suture.
The purse string suture is tied. Using the same suture, the purse
string is now sewn on the anterior abdominal wall, 3 cm inferior to the
entry site of the jejunostomy catheter.
Using the ENDOSTITCH* instrument, sutures are placed from the jejunum
(3 cm from the jejunum insertion site), into the proximal wing (hole in
wing) and into the anterior abdominal wall.
The jejunostomy catheter is now held between the jejunum and the
anterior abdominal wall. In most cases, two additional sutures are placed
to further secure the catheter onto the abdominal wall [using the "wings
of the tube"].
Alternate Method to Secure the Jejunum to the Anterior
Abdominal Wall : The sutures used in this setting are
PolySorb Sutures 2.0 (Absorbable). Once the purse string suture has been
placed around the catheter entry site into the duodenum using a 7 inch or
12 inch Polysorb suture. The purse string is tied and cut as closely as
possible to the ENDOSTITCH* Needle. Again, the ENDOSTITCH* instrument is
used to suture the proximal wings of the MCI Jejunostomy Tube to the
antimesenteric border of the jejunum, going through the suture hole in the
wings themselves. The sutures are left long and cut as close as possible
to the ENDOSTITCH* needle.
An ENDO CLOSE* instrument is then inserted and each limb of silk suture
is grasped at its tip and pulled through the anterior abdominal wall (a
total of six suture limbs). The sutures are pulled tight (check with the
telescope) and tied on the anterior abdominal wall (outside). This
maneuver will attach the jejunum against the anterior abdominal wall
securely. The suture will be closed at skin level on the seventh
In all cases, a Blake Drain is left in intraabdominal position, next to
the jejunostomy site.