Gastric outlet obstruction: clinical presentations and its surgical management

Abstract

Background: Gastric outlet obstruction (GOO) mechanically impedes gastric emptying, normal emptying of the stomach. It is a diagnostic and therapeutic challenge for general surgeons in their daily practice. This paper highlights the etiology, clinical presentation and treatment outcome of GOO.Methods: A Prospective study was conducted on patients with GOO treated at Rajarajeswari medical college and hospital, Bangalore during September 2015 to august 2017. Data was tabulated and analyzed using descriptive statistical methodology.Results: Carcinoma stomach with antral growth and cicatrized duodenal ulcer (both 41.5%) were the most common cause of gastric outlet obstruction. Male were more affected than females (2.5:1). Most common symptom was vomiting and abdominal pain (noted among all), followed by loss of appetite (83%) and loss of weight (82.35%). 94.1% patients of Cicatrized duodenal ulcer underwent truncal vagotomy with posterior gastrojejunostomy and 5.9% underwent truncal vagotomy with antrectomy. 58.8% patients of carcinoma stomach, underwent distal gastrectomy with ante-colic Roux-en-Y gastro- jejunostomy, 12.1% patients underwent subtotal gastrectomy with ante-colic and Roux-en-Y gastro jejunostomy and 4.8% patients underwent palliative gastrojejunostomy. In corrosive antral stricture Billroth I gastrectomy was done. Patients of pancreatic malignancy underwent palliative anterior gastrojejunostomy and pseudo- pancreatic cyst was treated by cystojejunostomy. The average hospital stay was 10-14 days and an overall mortality of 5.8% for malignant patients was noted.Conclusions: Study concludes that gastric outlet obstruction is an important and a common surgical condition in tertiary hospital. Malignancy and benign cicatrized duodenal ulcer being the most common cause.