Gastrojejunostomy

Abstract

Indications • Peptic ulcer disease with gastric outlet obstruction • Gastric outlet obstruction from unresectable cancer of the pancreas, duodenum, and peri-ampullary origin Essential Steps 1. Upper midline incision. 2. Explore the abdomen and confirm pathology. 3. Identify the mobile portion of the greater curvature of stomach and loop of proximal jejunum. 4. If antecolic: • Measure jejunum 30 cm from the ligament of Treitz and bring antecolic (pull omentum to the right and pass jejunum to left of bulk of omentum). 5. If retrocolic: • Create a window in the transverse mesoco-lon to the left of the middle colic vessels. • Measure jejunum 30 cm from the ligament of Treitz and bring the loop retrocolic. 6. If stapled: • Align the loop and chosen region of greater curvature with two stay sutures of 3-0 silk. • Create gastrostomy and jejunostomy, and use suction/sponge forceps to remove any leftover particles of food and fiber from the stomach. • Insert linear cutting stapler and fire. • Check staple line for hemostasis. • Close enterotomies with linear stapler/two-layered sutured closure. 7. If sutured: • Align the loop and chosen region of greater curvature of stomach. • Place back wall of interrupted 3-0 silk Lembert sutures. • Open the stomach and jejunum and use suction/sponge forceps to remove any leftover particles of food and fiber from the stomach; achieve hemostasis. • Place an inner layer of continuous 3-0 Vicryl to posterior and anterior walls. • Place an outer layer of 3-0 silk Lembert sutures. 8. Check the anastomosis for integrity and patency of both limbs (afferent and efferent).