World Journal of Laparoscopic Surgery

Register      Login

VOLUME 14 , ISSUE 1 ( January-April, 2021 ) > List of Articles

RESEARCH ARTICLE

Laparoscopic Stapled Gastrojejunostomy in Non-operable Cases of Malignant Gastric Outlet Obstruction (GOO): A Retrospective Study

Hilal A Makhdoomi, Tajamul Rashid, Irfan N Mir, Suhail N Bhat, Asifa Azad

Keywords : Gastric outlet obstruction, Gastrojejunostomy, Palliation, Diagnostic Laparoscopy

Citation Information : Makhdoomi HA, Rashid T, Mir IN, Bhat SN, Azad A. Laparoscopic Stapled Gastrojejunostomy in Non-operable Cases of Malignant Gastric Outlet Obstruction (GOO): A Retrospective Study. World J Lap Surg 2021; 14 (1):43-45.

DOI: 10.5005/jp-journals-10033-1427

License: CC BY-NC 4.0

Published Online: 01-04-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Inability of gastric contents to go beyond the proximal duodenum is termed as gastric outlet obstruction (GOO). This may be partial or complete. A multitude of causes, benign/malignant, may lead to GOO of gastric and extra gastric origins. Malignant GOO is a common condition among locally advanced gastric cancer patients. One of the relative contraindications for surgery is the presence of advanced malignancy; in these cases, in which life expectancy may be limited to a few months, palliative surgical measures may improve the quality of life. The role of the laparoscopic approach in the treatment of GOO is under investigation and may represent a valid form of therapy with low morbidity. Materials and methods: This was a retrospective study conducted in the Department of General Surgery, Government Medical College, Srinagar, from May 2018 to May 2019. A total of 35 patients who were diagnosed as cases of non-operable malignant GOO were included in the study. All patients underwent laparoscopic stapled gastrojejunostomy after diagnostic laparoscopy. This study was aimed at operative time, time for making anastomosis, hospital stay, return of bowel sounds, and postoperative complications. Results: Mean age of patients in our study was 66.8 years with male predominance. Mean operative time was 94.35 minutes with a mean time of 20.4 minutes for making stapled anastomosis. Mean hospital stay, return of bowel sounds, and resumption of orals were 7.9, 2.28, and 3.85 days, respectively. Bleeding from the anastomotic site was noted in three patients and anastomotic leak was noted in one patient. Conclusion: Laparoscopic stapled gastrojejunostomy is a viable option for palliation in advanced cases of non-operable malignancies leading to GOO. It is associated with less operative times and less immediate postoperative complications. However, further studies are needed before laparoscopic stapled gastrojejunostomy is taken up as a standard for non-operable cases of malignant GOO.


PDF Share
  1. Samad A, Khanzada TW, Shoukat I. Gastric outlet obstruction: change in etiology. Pak J Surg 2007;23(1):29–32.
  2. Johnson CD. Gastric outlet obstruction malignant until proved otherwise. Am J Gastroenterol 1995;90(10):1740.
  3. Tendler DA. Malignant gastric outlet obstruction: bridging another divide. Am J Gastroenterol 2002;97(1):4–6. DOI: 10.1111/j.1572-0241.2002.05391.x.
  4. Shone DN, Nikoomanesh P, Smith-Meek MM, et al. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol 1995;90(10):1769–1770.
  5. Khuroo MS, Zargar SA, Mahajan R, et al. High incidence of oesophageal and gastric cancer in Kashmir in a population with special personal and dietary habits. Gut 1992;33(1):11–15. DOI: 10.1136/gut.33.1.11.
  6. Carcas LP. Gastric cancer review. J Carcinog 2014;13:14. DOI: 10.4103/1477-3163.146506.
  7. Stupart DA, Panieri E, Dent DM. Gastrojejunostomy for gastric outlet obstruction in patients with gastric carcinoma. S Afr J Surg 2006;44(2):52–54.
  8. Gurusamy KS, Kumar S, Davidson BR. Prophylactic gastrojejunostomy for unresectable periampullary carcinoma. Cochrane Database Syst Rev 2010;(10):CD008533. DOI: 10.1002/14651858.CD008533.pub2.
  9. Zhang LP, Tabrizian P, Nguyen S, et al. Laparoscopic gastrojejunostomy for the treatment of gastric outlet obstruction. JSLS 2011;15(2):169–173. DOI: 10.4293/108680811X13022985132074.
  10. Seo SH, Kim KH, Kim MC, et al. Comparative study of hand-sutured versus circular stapled anastomosis for gastrojejunostomy in laparoscopy assisted distal gastrectomy. J Gastric Cancer 2012;12(2):120–125. DOI: 10.5230/jgc.2012.12.2.120.
  11. Jaka H, Mchembe MD, Rambau PF, et al. Gastric outlet obstruction at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 184 cases. BMC Surg 2013;13:41. DOI: 10.1186/1471-2482-13-41.
  12. Pournaras DJ, Jafferbhoy S, Titcomb DR, et al. Three hundred laparoscopic Roux-en-Y gastric bypasses: managing the learning curve in higher risk patients. Obes Surg 2010;20(3):290–294. DOI: 10.1007/s11695-009-9914-7.
  13. Navarra G, Musolino C, Venneri A, et al. Palliative antecolic isoperistaltic gastrojejunostomy: a randomized controlled trial comparing open and laparoscopic approaches. Surg Endosc 2006;20(12):1831–1834. DOI: 10.1007/s00464-005-0454-5.
  14. Al-Rashedy M, Dadibhai M, Shareif A, et al. Laparoscopic gastric bypass for gastric outlet obstruction is associated with smoother, faster recovery and shorter hospital stay compared with open surgery. J Hepatobiliary Pancreat Surg 2005;12(6):474–478. DOI: 10.1007/s00534-005-1013-0.
  15. Alam TA, Baines M, Parker MC. The management of gastric outlet obstruction secondary to inoperable cancer. Surg Endosc 2003;17(2):320–323. DOI: 10.1007/s00464-001-9197-0.
  16. Kazanjian KK, Reber HA, Hines OJ. Laparoscopic gastrojejunostomy for gastric outlet obstruction in pancreatic cancer. Am Surg 2004;70(10):910–913.
  17. Gonzalez R, Lin E, Venkatesh KR, et al. Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 2003;138(2):181–184. DOI: 10.1001/archsurg.138.2.181.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.