Outcomes of duodenojejunostomy (the Grégoire procedure) for obstruction or perforation of the third and fourth portions of the duodenum

Abstract

AimAlthough obstruction and perforation of the third and fourth portions of the duodenum are rare, they are usually encountered in an emergency setting. The objective of the present study was to characterize the outcomes of duodenojejunostomy for the obstruction or perforation of the third and fourth portions of the duodenum.Patients and MethodsThis was a retrospective, single‐centre study (evidence level V). From January 2004 to March 2013, all patients having undergone a duodenojejunostomy for damage to the third or fourth portions of the duodenum were included in the study.ResultsThe study population consisted of three women (33.3 per cent) and six men (66.7 men). The mean age was 52 years (range: 22–81). Three patients (33.3 per cent) had an obstruction, and the remaining six (66.7 per cent) had a perforation. The aetiology for all cases of obstruction was jejunal metastasis of lung cancer (n = 3). The mean operating time was 190.7 min (range: 100–275). All anastomoses were lateroterminal and were hand‐sewn between the genu inferius and the first jejunal loop. The mean time to refeeding was 6 days (range: 5–9), and the mean duration of postoperative gastroparesis was 8 days (range: 4–21). The mean length of hospital stay was 23 days (range: 15–50). The median Clavien score was 2 (0–5). The mortality rate was 11.2 per cent (n = 1).ConclusionDuodenojejunostomy protects patients from obstruction and enables rapid refeeding. It has an acceptable morbidity rate and can be easily performed in an emergency setting.