How is a gastrojejunostomy performed?
A gastrojejunostomy is a surgical procedure performed under general anesthesia by a gastrointestinal surgeon. The surgeon produces a direct connection (anastomosis) between the stomach and the jejunum, part of the small intestine.
Prior to a gastrojejunostomy a patient may be required to
- Undergo blood, urine and imaging tests.
- Avoid eating or drinking 8 hours prior to the procedure.
- Check with the doctor before taking any regular medications.
- Inform the doctor of any allergies.
A precautionary course of antibiotics may be given to the patients. Stabilization of patients with severe gastric outlet obstruction may be done prior to the surgery. Treatment may be undertaken for problems such as
- Dehydration -- with IV saline
- Low potassium -- with supplemental potassium
- Anemia from bleeding -- with blood transfusion
- Residual stomach contents -- with stomach pumping (gastric lavage)
- An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the procedure.
- The patient will be intubated to provide oxygen.
- The surgeon makes one or more incisions in the abdomen depending on the type of surgery.
- In case of removal or bypass of the stomach outlet (pylorus) and duodenum, the surgeon makes a surgical outlet in the stomach (stoma) and connects the jejunum directly to the stomach (anastomosis).
- If the surgeon removes a part of the stomach, the remaining portion of the stomach will be connected to the jejunum.
- The anastomosis may be closed with sutures or staples.
- The abdominal muscles and the incision are closed with sutures.
- The patient will be brought out of anesthesia and administered painkillers for post-surgical pain.
- The patient will be monitored in the recovery room for several hours.
- Percutaneous gastrojejunostomy does not require general anesthesia. The doctor may use local anesthetic and mild sedation.
- Guided by ultrasound imaging the doctor inserts a needle along with a guiding wire, in the stomach wall.
- The feeding tube may be placed in the jejunum either by
- pushing through the stomach wall, or
- passing the tube through the nose, down the upper digestive tract to the jejunum and pulled out of the stomach wall.
- The needle and guiding wire are withdrawn.
- Endoscopic gastrojejunostomy is a minimally invasive procedure. A light sedation may be used along with painkillers.
- A flexible viewing tube (endoscope) is advanced through the nose, esophagus, stomach, and duodenum into the jejunum.
- The procedure will be guided by images on the monitor.
- If there is obstruction in the duodenum and the scope cannot get through, a needle is used to puncture the stomach and enter the jejunum.
- A self-expanding metal stent is placed in the jejunum.
- The endoscope is gently withdrawn.
How long does it take to recover from a gastrojejunostomy procedure?
The recovery time depends on the type of procedure and the patient’s underlying condition.
- For an open surgery the patient may require 10 or more days of hospitalization.
- Laparoscopic surgery may require hospitalization of two to three days.
- Complete recovery from the surgery may take up to six weeks during which period the patient may be required to
- follow a specific diet
- avoid spicy and acidic foods
- avoid heavy lifting
- avoid strenuous activities
With percutaneous and endoscopic gastrojejunostomy the patient may be able to recover within 24 hours. Temporary procedures will require reversal. Complete recovery depends on the underlying condition of the patient.
What are the risks and complications of a gastrojejunostomy?
Surgeons routinely perform gastrojejunostomy and it is a relatively safe surgery. The severity of risks and complications mostly depend on the underlying condition of the patient.
The risks include:
- Side effects of anesthesia such as
- Risks of surgery such as
- Anastomotic leakage
- Anastomotic stricture
- Complications of other accompanying surgeries such as vagotomy or gastrectomy
- Gastric dumping syndrome due to the stomach contents emptying too quickly into the intestine
- Bile reflux and chronic gastritis
- Bowel blockage
- Inflammation of the stomach lining (peritonitis)
- Weight loss and fatigue
- Infection and sepsis
- Lack of relief from the underlying condition
- Percutaneous and endoscopic gastrojejunostomy are technically safe procedures. The main risk from these procedures are
- Lack of relief from symptoms
- Short-term efficacy
- Pain and infection at the puncture site