Laparoscopic Gastrojejunostomy (stomach-small bowel connection)

A. The Condition. You may have a condition in which food cannot pass out of your stomach. In this situation, your surgeon will bypass the blockage by connecting your intestine directly to your stomach.

Dr. Frantzides was the first in the world to perform and publish a laparoscopic gastroduodenostomy for gastric outlet obstruction in 1996.

B. Symptoms

• Nausea, vomiting
• Crampy abdominal pain
• Weight loss, weakness

C. Laparoscopic Gastrojejunostomy. The surgeon will make about 3-4 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to connect the small intestine (jejunum) to the stomach. This is done with surgical staplers. After this has been accomplished, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

D. Nonsurgical Treatment. Sometimes your problem may be treated with suctioning out the stomach, withholding food for several days, and giving IV fluids. Your doctor will discuss with you what your best option is.

E. Risks. The primary risks of laparoscopic gastrojejunostomy are:

• Infection of the skin at one of the small ports sites
• Leakage of the connection between the stomach and small bowel
• Collection of pus inside your abdomen (intraabdominal abscess)
• Postoperative ileus (the intestines slow down/stop working for several days)
• Small bowel obstruction (kinking of the small bowel, causing blockage)

F. Expectations

1. Before Your Operation. Laparoscopic gastrojejunostomy usually is an elective procedure. The preoperative evaluation might include blood work, urinalysis, a barium swallow x-ray, endoscopy (looking down your throat with a scope), and perhaps an abdominal CT scan. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, Lovenox, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home in 2-4 days after a laparoscopic gastrojejunostomy. You may need to wait until your bowels start working. You will be given medication for pain. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• High fever
• Severe abdominal pain
• Odor or increased drainage from your incision
• No bowel movements for three days

G. Pertinent References

Frantzides CT, Zografakis JG. “Laparoscopic Bypass with Roux-en-Y Gastrojejunostomy.” In: Frantzides CT, Carlson MA, eds. Atlas of Minimally Invasive Surgery. Philadelphia: Saunders Elsevier, 2009.

Parikh M, Pomp A. “Laparoscopic Total Gastrectomy For Malignancy.” In: Frantzides CT, Carlson MA, eds. Atlas of Minimally Invasive Surgery. Philadelphia: Saunders Elsevier, 2009.

Frantzides CT, Carlson M. A, “Laparoscopic gastroduodenostomy for gastric outlet obstruction” J. Laparoendosc. Surg. 6:341-344, 1996.