From the Guidelines
A gastrojejunostomy (GJ) is a surgical procedure that creates a connection between the stomach and the jejunum, and for patients with gastric outlet obstruction, a laparoscopic approach is favored over an open approach due to lower blood loss and shorter hospital stay. This procedure is typically performed to treat conditions that obstruct the normal passage of food, such as peptic ulcers, stomach cancer, or duodenal obstruction. The key benefits of a laparoscopic approach, as highlighted in the 2021 study by 1, include reduced blood loss and shorter hospital stays.
Key Considerations
- The procedure can be done using open surgery or minimally invasive laparoscopic techniques, with laparoscopic being the preferred method for eligible patients 1.
- After surgery, patients usually stay in the hospital for several days and follow a progressive diet starting with clear liquids and advancing to solid foods as tolerated.
- Pain management typically includes medications like acetaminophen or opioids as needed, with dosing based on individual patient factors.
- Potential complications include bleeding, infection, leakage at the surgical connection, and dumping syndrome (rapid emptying of stomach contents into the small intestine causing symptoms like nausea, vomiting, and diarrhea) 1.
Patient Selection
The decision to perform a surgical GJ should be based on the patient's overall health, life expectancy, and ability to undergo surgery. As noted in the study by 1, patients with life expectancy more than 2 months who are surgically fit should undergo surgical GJ, whereas those with less should undergo enteral stent placement. Additionally, factors such as poor nutritional status, ascites, and poor functional status have been identified as independent predictors of clinical failure of a surgical GJ 1.
Surgical Approach
Laparoscopic surgical gastrojejunostomy is the preferred approach for patients with gastric outlet obstruction, as it offers significant benefits over open surgery, including lower blood loss and shorter hospital stays 1. The SUSTENT study, referenced in 1, further supports the use of surgical GJ over enteral stent placement for long-term relief in eligible patients.
From the Research
Definition and Purpose of Gastrojejunostomy
- A gastrojejunostomy (GJ) is a surgical procedure that creates an anastomosis between the stomach (gastro) and the jejunum (jejunostomy) 2.
- The primary purpose of this procedure is to allow nutrition to be infused directly into the jejunum, bypassing the stomach, in cases where the upper digestive tract is obstructed or not functioning properly 2, 3, 4.
Techniques and Indications
- There are various techniques used for gastrojejunostomy, including open gastrojejunostomy, laparoscopic gastrojejunostomy, and hand-sewn anastomosis 2, 3, 5.
- The indications for gastrojejunostomy include gastric outlet obstruction, malignant and benign diseases, and conditions requiring palliation, such as unresectable pancreatic cancer 3, 4.
- Gastrojejunostomy can also be performed as part of a larger surgical procedure, such as a laparoscopic Roux-en-Y gastric bypass 5.
Complications and Outcomes
- The complications associated with gastrojejunostomy can be mechanical, infectious, gastrointestinal, or metabolic 2.
- The rate of technical complications varies depending on the technique used, with laparoscopic gastrojejunostomy having a relatively low complication rate compared to open gastrojejunostomy 3, 4.
- The outcomes of gastrojejunostomy can be successful in palliating symptoms and improving quality of life, with some studies reporting high success rates and low mortality rates 3, 4, 6.
Novel Techniques and Modifications
- New techniques and modifications to gastrojejunostomy are being developed to improve outcomes and reduce complications, such as the gastric-jejunum pouch side-to-end anastomosis 6.
- These novel techniques aim to prevent reflux gastritis and improve surgical safety, with promising results reported in some studies 6.