Catheter jejunostomy - general and visceral surgery

Puncture the right lateral abdominal wall with the peel-away cannula and insert the catheter into the abdominal cavity.

Locate the second loop  of the jejunum. Here, first puncture the serosa with the second peel-away cannula, then advance the cannula external to the mucosa for a distance of 6-8 cm before puncturing the mucous membrane.

Now insert the catheter into the lumen of the jejunum and remove the peel-away cannula.

Advance the catheter about 25 cm into the intestinal lumen and the close the intestinal insertion site of the catheter with a purse string suture.

Cover the purse string suture with several interrupted seroserous sutures.

Fixate the catheter insertion site on the parietal peritoneum of the lateral abdominal wall. This is accomplished by running a continuous purse-string suture around the insertion sites in the visceral and parietal peritoneum. Once this suture is tightened the catheter is covered completely, and the visceral lamina will adhere to the parietal lamina of the peritoneum. This effects optimum protection against secondary catheter dislocation into the free abominal cavity.

Complete the procedure by suturing the external fixation plate to the skin.