Laparoscopic gastrojejunostomy for the treatment of gastric outlet obstruction

Abstract

Background and objectives: Laparoscopic gastrojejunostomy (LGJ) has been proposed as the technique preferred over open gastrojejunostomy for relieving gastric outlet obstruction (GOO) due to malignant and benign disease. This study investigates the feasibility and safety of LGJ for GOO.

Methods: A retrospective review was performed of patients who underwent LGJ at Mount Sinai Medical Center from 2004 to 2008. Patient's operative course and longterm outcomes were collected.

Results: Twenty-eight patients were reviewed (16 had malignancy, 7 had PUD, 3 had Crohn's disease, and one had obstruction of unclear cause). Average operative time was 170 minutes, and estimated blood loss was 80cc. One case was converted to open; another had stapler misfiring. Patients regained bowel function at a median of 3 days and remained in the hospital for a median of 8 days. There were 4 major postoperative complications (14%): 1 anastomotic leak and 1 trocar-site hemorrhage requiring reoperation and 2 gastrointestinal bleeds requiring endoscopic intervention. There were 5 minor complications (18%), including a partial small bowel obstruction, 1 patient developed bacteremia, and 3 patients had delayed gastric emptying. One patient had persistent GOO requiring reoperation 3 months later.

Conclusion: LGJ can be performed for GOO with improved outcome and an acceptable complication rate compared to the open GJ reported in the literature.