Laparoscopic Gastrojejunostomy Research Articles

Staged laparoscopic management of locally advanced gastric cancer with outlet obstruction.

The prognosis of patients with locally advanced gastric cancer with outlet obstruction is poor. Gastrectomy with curative intent is often initially impossible or difficult. We report our experience of curative distal gastrectomy after laparoscopic gastrojejunostomy and fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy to examine the feasibility and safety of this modified strategy for locally advanced gastric cancer with outlet obstruction, initially deemed unresectable. Between October 2017 and June 2019, 15 patients diagnosed with locally advanced gastric cancer with outlet obstruction sequentially underwent gastrojejunostomy, received four cycles of FLOT chemotherapy, and underwent laparoscopic distal gastrectomy with curative intent (R0 resection + D2 lymphadenectomy). Clinical data were retrospectively collected and analyzed. R0 resection was possible in 12/15 patients, laparoscopically in 11, and one conversion to laparotomy was necessary. There was no perioperative mortality in the 12 patients. Pathologic evaluation of the resected specimens revealed that complete tumor grade regression1a (TRG1a), TRG1b, TRG2, and TRG3 occurred in 3, 2, 4, and 3 patients, respectively. This case series showed that curative surgical resection was feasible as a staged approach for patients with locally advanced gastric cancer with outlet obstruction, after initial staged gastrojejunostomy and chemotherapy.

Palliative gastrojejunostomy in unresectable cancer and gastric outlet obstruction: a retrospective cohort study.

Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre. We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival. A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups. Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.

LAP STAPLER GASTROJEJUNOSTOMY WITH TOTAL TRUNCAL VAGOTOMY FOR BENIGN GASTRIC OUTLET OBSTRUCTION.

Aims: To study the advantages and disadvantages of laparoscopic truncal vagotomy and gastrojejunostomy, the outcome of surgery in terms of – mean operative time, Conversion rate, Postoperative pain measurement, intraoperative and postoperative complication and duration of hospital stay.&#x0D; Methods: A prospective analysis of operative, postoperative and short term outcome of 21 patients were carried out during time period of 2016 to 2019.&#x0D; Results: Out of 21 patient,.64% patients were males and 36 % patients were females. Male to female ratio was 1.7: 1. The mean operative time required was 130 minutes and the mean pain scale measured was 3 ± 0.81 on second day .The incidence of intraoperative and early postoperative complication was 5.26 % and 10.52 % respectively. The mean length of hospital stay was 8 days. Average follow up duration was 12 months.&#x0D; Conclusion: It is viable and safe option with shorter operative time and length of stay. It can be performed successfully with minimal morbidity and no mortality. However extreme care and skill is required to identify anatomy and handling of stapler.&#x0D; Keywords: Laparoscopy; Stapler Gastrojejunostomy; Vagotomy; Endoscopy.

Comparative study of outcome and complications of surgical management of benign gastric outlet obstruction

Background: Gastric outlet obstruction (GOO) implies complete or incomplete obstruction of the distal stomach, pylorus, or proximal duodenum. There are many causes of benign GOO like acid ingestion, pyloric stenosis, peptic ulcer etc. The main aims of this study were to compare the perioperative morbidity and short and long term complications of different procedures for benign gastric outlet obstruction.Methods: This non-randomised retrospective study was undertaken in the department of General Surgery, SMIMER Hospital, Surat, Gujarat, India from August 2016 to July 2019. Thirty patients had been operated during this period and included in the study. Records of all 30 patients were retrieved and analysed. All these patients underwent pre-operatively upper GI scopy with biopsy and CECT abdomen.Results: Nausea and Vomiting was most common symptoms at time of presentation in our study. Incidence of wound infection in open Gastrojejunostomy group was very high i.e. 25% and hospital stay was also very high in open Gastrojejunostomy group. Post-operative PPI dependence was more common in Gastro-jejunostomy group in all follow up and there was no any requirement of PPI in Heineke-Mikukicz and Finney’s pyloroplasty group.Conclusions: On comparison of different surgical modalities for management of benign GOO, all surgeries performed laparoscopically were safe and carried comparatively less morbidities (perioperative, short term and long term) in comparison to open methods. Among all three laparoscopic procedures, outcome of laparoscopic pyloroplasty, both H-M pyloroplasty and Finney’s pyloroplasty were better than laparoscopic gastro-jejunostomy.

Su1282 OUTCOMES OF PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION USING EUS-GUIDED GASTROENTEROSTOMY VS. ENDOSCOPIC STENTING VS. SURGICAL GASTROJEJUNOSTOMY: A POOLED ANALYSIS

Gastric outlet obstruction (GOO) results most commonly from malignancy leading to mechanical obstruction of the distal stomach or proximal duodenum. GOO is debilitating as it impairs the quality of life, and the nutritional and volume status of affected patients. Traditionally, surgical gastrojejunostomy (GJ) and self-expandable metal stents have been considered the mainstay treatment. More recently, Endoscopic ultrasound-guided gastroenterostomy (EUS-GE), using lumen-apposing metal stents, have been introduced as a third option. To date, a pooled analysis of the outcomes of comparative studies of these four techniques does not exist. The aim of this study was to provide a pooled estimate of these techniques' outcomes. PubMed, Web of Science, Google Scholar and Embase search was performed for eligible studies using the combination of the following terms: ‘gastric outlet obstruction', ‘duodenal obstruction', ‘neoplasm', ‘gastrojejunostomy', ‘laparoscopy', ‘laparotomy', ‘stents', ‘endoscopy', ‘endosonography' and ‘gastric bypass'. Original articles directly comparing two out of the four techniques (Open GJ vs. Laparoscopic GJ vs. Enteral stent vs. EUS-GE) for alleviating malignant gastric outlet obstruction were selected. The PRISMA flow diagram depicts the selection process. The primary outcomes were: overall pooled technical and clinical success. Secondary outcomes included pooled mean length of hospital stay and adverse events and complication rate. Studies performed on non-human subjects and those not differentiating the surgical approach used (open vs. laparoscopic) were excluded. Statistical software Open MetaAnalyst was used for analysis with pooled proportions and means reported with 95% Confidence intervals (CI) and heterogeneity (I2). Nineteen studies were included in the final analysis: 17 were retrospective and 2 were prospective. The pooled total number of patients was 1,853. Mean age was 68, 64, 66, and 64 for EUS-GE, enteral stent, open and lap GJ respectively. Reported mean follow-up duration was 175, 98, 140 and 650 days for EUS-GE, enteral stent, open and lap GJ respectively. The overall pooled clinical success rate was 89.3 (95%CI:82.7 – 95.8), 88 (95% CI:82.4-93.6), 89 (95%CI:82.3-95.7), and 92.3% (95%CI:86.6-97.9) for EUS-GE, enteral stent, open and lap GJ respectively. The overall pooled technical, clinical and complication rates, in addition to the mean length of stay are reported in table 1. The lowest heterogeneity among studied outcomes was found in the EUS-GE arm possibly correlating with a more standardized approach among the tertiary centers performing it. Herein we report based on our pooled analysis that EUS-GE appears to have comparable outcomes and safety profile to the more traditional techniques. EUS-GE is minimally invasive and has long-term efficacy in alleviating GOO.Table 1Overall pooled technical, clinical and complications rate, and mean length of hospital stay in each of the 4 arms. 95% CI: Confidence Interval; I2: heterogenity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A Case of Antral Stenosis after Corrosive Gastritis Treated by Laparoscopic Gastrojejunostomy

A Case of Antral Stenosis after Corrosive Gastritis Treated by Laparoscopic Gastrojejunostomy

Laparoscopic stomach‐partitioning gastrojejunostomy in preparation for distal gastrectomy and Billroth‐II reconstruction after neoadjuvant chemotherapy for advanced gastric cancer with gastric outlet obstruction: A case report

Gastrojejunostomy has been performed as a palliative treatment for unresectable, advanced gastric cancer patients with gastric outlet obstruction (GOO). However, its role before neoadjuvant chemotherapy (NAC) has not been established. We present the case of a 72-year-old man with distal advanced gastric cancer with GOO. Computed tomography showed para-aortic lymph node (PAN) metastasis without other distal metastasis. We performed laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ), which avoided new gastrojejunostomy reconstruction when performing distal gastrectomy after NAC. His oral intake improved after surgery and NAC was successfully administered on postoperative day 14, without surgical complications. After completion of NAC, the patient underwent radical distal gastrectomy with gastrojejunostomy reused as Billroth-II reconstruction. A histological examination revealed no residual cancer cells. LSPGJ, with partitioning on the expected resection line in distal gastrectomy after NAC, can be useful for treating advanced gastric cancer with GOO when NAC followed by curative gastrectomy is planned.

Hybrid fluorescent magnetic gastrojejunostomy: an experimental feasibility study in the porcine model and human cadaver.

Laparoscopic gastrojejunostomies are time consuming and require a specific training. Alternatively, sutureless anastomosis can be achieved using endoscopically delivered magnetic rings. Our aim was to assess the feasibility and reproducibility of an endo-laparoscopic gastrojejunostomy technique, using a pair of magnets coated with a near-infrared fluorescent biocompatible polymeric material. Five pigs (3 acute and 2 survival models) and one human anatomical specimen were included. In the survival models, the distal ring was inserted into the duodenum endoscopically, and it was fixed to a thread clipped to the gastric mucosa. Twenty-four hours later, a two-port laparoscopy was performed using a near-infrared (NIR) laparoscope. The magnet position in the jejunum was detected with the transluminal fluorescence of the dye. Magnetic interaction with the metallic tip of the laparoscopic grasper allowed to capture the ring and bring the bowel loop to the future anastomotic site on the gastric wall. The proximal magnet was inserted into the stomach endoscopically and released when magnetic interaction started, allowing for a precise connection with the distal ring. The animals were followed up for 12days and underwent control endoscopies and radiograms. In the acute animals, the anastomotic procedure was repeated 24 times. Finally, the procedure was performed in the human anatomical specimen. There were no technical problems, and magnetic connection could be precisely directed at both the anterior and posterior gastric walls. No complications occurred during the survival period and the anastomoses were patent on day 5. Transluminal fluorescence enabled a rapid detection of the magnet. Hybrid-reduced port magnetic gastrojejunostomy using a pair of fluorescently coated magnetic rings was feasible, reproducible, and easy to perform in both porcine and cadaver models.

Occupational cholangiocarcinoma diagnosed 18\u2009years after the end of exposure to 1,2-dichloropropane and dichloromethane at a printing company: a case report

BackgroundCholangiocarcinoma due to exposure to 1.2-dichloropropane (DCP) or dichloromethane (DCM) is classified as occupational cholangiocarcinoma. We report a case of occupational cholangiocarcinoma diagnosed 18 years after the end of exposure to organic solvents at a printing company.Case presentationA 41-year-old man presented to our hospital with jaundice and anorexia. He had previously worked for 6 years at a printing company where an outbreak of occupational cholangiocarcinoma occurred and was exposed to high concentrations of organic solvents during his employment. Computed tomography demonstrated lower bile duct obstruction by the bulky nodal metastasis at the hepatoduodenal ligament with upstream biliary dilatation, an intraductal papillary tumor in the dilated left superior lateral bile duct (B2), and enlargement of the periaortic nodes. Clinical diagnosis of an unresectable invasive intraductal papillary neoplasm of the bile duct (IPNB) with extensive nodal metastasis was made. Although chemotherapy and laparoscopic gastrojejunostomy were performed for the duodenal obstruction, the patient died due to rupture of the tumor. Pathological examination of the autopsy specimen revealed well-differentiated adenocarcinoma at the stromal site along Glisson’s sheath in segment 3, an IPNB lesion without invasion in B2, and biliary intraepithelial neoplasia and chronic bile duct injury at various sites in the large bile ducts. The bulky lymph node (poorly differentiated adenocarcinoma with partial squamous cell differentiation) invaded the bile duct and duodenum.ConclusionsWe report a case of occupational cholangiocarcinoma that developed 18 years after the end of exposure to DCP and DCM. Long-term follow-up is required to carefully survey development of cholangiocarcinoma in workers with an occupational history of exposure to organic solvents.

Efficacy of Endoscopic Ultrasonography-Guided Gastroenterostomy (EUS-GE) in Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-Analysis

Introduction: Gastric outlet obstruction (GOO) is a sequela of several benign and malignant diseases. Laparoscopic gastrojejunostomy or enteral stenting have been the two common options in standard management algorithm of GOO. Endoscopic ultrasonography guided gastroenterostomy (EUS-GE) is emerging as an alternative newer technique for management of patients with GOO. We conducted a systematic review and meta-analysis to assess the overall technical and clinical success and adverse events of EUS-GE. Methods: Multiple electronic databases (MEDLINE, EMBASE and Google Scholar) and conference abstracts were comprehensively searched to identify studies reporting EUS-GE in patients with GOO. References from these identified studies were then manually searched to detect any additional studies. The primary outcome of our meta-analysis was assessment of the overall pooled technical and clinical success of this procedure. Secondary outcome included overall adverse events associated with it. The meta-analysis was performed using Der Simonian and Laird random effect model. Results: A total of ten studies were included in the final meta-analysis, reporting 263 patients (males 135 and females 128) with a median age of 61.2 years. The median follow-up duration was 110 days. The overall pooled technical and clinical success rates of the procedure were 92.4% (95% CI= 89-95, I2=0) and 88.5% (95%CI= 84.5-92.5, I2 =0) respectively. The overall adverse events were 8.1% (95%CI= 4.1-11.9, I2 =23%), which included stent migration (n=2) and peritoneal stent deployment (n=15). Conclusion: EUS-GE appears to be a safe and effective endoscopic technique in patients with GOO, with overall high technical and clinical success rates (92.4%, 88.5% respectively), and reasonable safety profile. Although further randomized control trials are needed to validate these findings, our meta-analysis suggests that EUS-GE can be offered as a minimally invasive endoscopic alternative to GOO patients with challenging or failed enteral stenting, or those who are not deemed surgical candidates.809_A Figure 1. Forest plot demonstrating the overall technical success rate809_B Figure 2. Forest plot demonstrating the overall clinical success rate809_C Figure 3. Forest plot demonstrating the overall adverse event rates

P3-064 - A case of duodenum dissemination after surgery for colon cancer which immunotherapy was significantly effective

The patient was a 73 year old woman who received surgery for transverse colon cancer in December 2014. Histopathologic examination findings were tub2, pT4b, pN1, sH0, sM0, ly2, v0, Stage IIIa. After XELOX theraphy two courses were performed, FOLFIRI plus Pmab theraphy twelve courses were performed. Stenosis due to duodenum dissemination was observed in December 2015, and a laparoscopic gastrojejunostomy was performed. Later, the tumor marker value of the patient significantly increased, and enlargement of duodenum dissemination was observed by abdominal CT. From April 2016, treatment was switched to mFOLFOX6 plus Pmab theraphy and five courses were subsequently performed. Still, metastasis to the abdominal wall was observed. According to results of the microsatellite instability test of MSI-H, the patient was registered into a clinical trial for Pembrolizumab, which is anti-PD-1, and administration began from June. The tumor marker value significantly decreased, and a reduction in the size of the duodenum dissemination over time could also be observed by abdominal CT. Significant tumor reduction was observed, indicating that immune therapy may be significantly effective in some cases.

Laparoscopic gastrojejunostomy for gastric outlet obstruction: personal serie

Traditionally, benign diseases were responsible for most of the causes of gastric outlet obstruction (GOO), but in recent years, 50-80% could be attributable to malignancy. Malignancy includes distal gastric cancer and hepatobiliary-pancreatic (HBP) neoplasms. In metastatic/unresectable HPB tumors, GOO decrease quality of life and treatment should be necessary. Options are duodenal stent or gastrojejunostomy (GJ), but there is no consensus. In benign diseases, 1-5% of patients with chronic pancreatitis (PC) would develop GOO. We retrospectively review all consecutive patients who underwent laparoscopic GJ for GOO due to CP or advanced HBP cancer at University Hospital of Guadalajara, Spain. We studied 10 patients with laparoscopic GJ. HBP neoplasms: Age: 78,01±6,8 years. Albumin: 28,36 ±2,7. No patient received prior chemo. Tabled 1EP02F-021 TableAge/SexGOOSSClinical successTime to initiate intakeLOS (days)Duration of food intake77/F0Yes412402 (until death)76/M3Yes312228(until death)91/F0Yes15278 (until death)78/F0Yes3107868/M0YesND128276/M0YesND13220 (until death)76/F0YesND5ND Open table in a new tab CP: 3 males. Age: 56,2±3,4. Median albumin: 37,7±6,6. Clinical success: 100%. Median LOS: 6,33±0,6. Previous literature on GOO treatment mixes different causes with different prognosis, so level of evidence is low. In benign diseases, such as CP, data are limited and patients typically requires surgical GJ. In malignancy, literature on GJ showed better long-term relief and lower reintervention rates. In other hand, stents are associated with lower hospital stay, faster initial relief and shorter time to intake, with more recurrent symptoms. Survival is essential for the choice of treatment. In HBP neoplasms, chemotherapy has increased survival. Stent is usually preferred in patients with poor general condition or life expectancy of less than 90 days but more studies are needed to standardize treatment. Laparoscopic GJ is a feasible, safe and efficient technical option.

Comparison of Treatment Outcomes of Endoscopic Stenting and Laparoscopic Gastrojejunostomy for Malignant Gastric Outlet Obstruction

To compare the clinic outcomes of endoscopic stenting and laparoscopic gastrojejunostomy (LGJ) for patients with malignant gastric outlet obstruction (GOO). We retrospectively reviewed 63 patients with malignant GOO that underwent endoscopic stenting [Stent Group (SG), n = 29] or LGJ [Laparoscopic Group (LG), n = 34]. Then, we evaluated the medical effects, postoperative hospital stay, and hospitalization expenses in both groups. Compared to LG, SG has a shorter operation time [SG: (41.1 ± 9.3) minutes vs LG: (137.4 ± 21.7) minutes, P = 0.000], less intraoperative blood loss [(23.7 ± 9.0) mL vs (121.1 ± 24.3) mL, P = 0.000], relatively lower hospitalization expenses [(2272.7 ± 413.9) $ vs (5182.4 ± 517.3) $, P = 0.000]. Besides, the median intake time was significantly shorter in the SG than that in the LG [(0.9 ± 0.3) days vs (4.1 ± 0.6) days, P = 0.000]. However, there were no significant differences between SG with LG in surgical success rate (100 vs 100%, P = 1.000), length of hospital stay [(6.1 ± 3.3) days vs (10.9 ± 4.7) days, P = 0.422], recurrent obstructive rate (37.9 vs 26.5%, P = 0.949) and median survivals [(141.4 ± 81.4) days vs (122.7 ± 88.8) days, P = 0.879]. Endoscopic stenting and LGJ are both relatively safe and effective treatments for patients with malignant GOO. But we suggest that endoscopic stenting should be considered first in patients with malignant GOO because it has many advantages over LGJ.

Su1449 EUS-GUIDED GASTROJEJUNOSTOMY USING A LUMEN APPOSING METAL STENT IN PATIENTS WITH SYMPTOMATIC GASTRIC OUTLET OBSTRUCTION

EUS gastrojejunostomy (GJ) is emerging as an alternative novel technique in patients with symptomatic gastric outlet obstructions (GOO) who have advanced malignancy. Recent studies have shown that the EUS-guided approach has less adverse events and is more cost-effective compared to laparoscopic GJ. We share our experience of 5 patients who underwent EUS Guided GJ with favourable outcomes. Five patients with symptomatic gastric outlet obstruction underwent EUS-guided GJ interventions from May 2017 to November 2017. Patients were informed of the potential risks of this novel procedure and informed consent was taken. Technical success was defined as successful deployment of lumen apposing metal stents (LAMS); while clinical success was the ability to tolerate diet. Median age was 61.5 (Range 53-83) years. GOO was secondary to advanced pancreatic malignancy (4) and duodenal malignancy (1). Two patients had altered anatomy from previous post bilroth gastrectomy and Roux-en-Y hepaticojejunostomy. For all five patients with GOO, LAMS 15mm diameter with electrocautery-enhanced delivery system was used to create the GJ anastomosis. Identification of the distal jejunal limb was done with an inflated balloon catheter and this was use as a target for direct puncture with a 19G needle. All five interventions had technical success with median procedure time of 80min (38-163 range). All stents were dilated up to their corresponding diameters. Duration of stay after procedure was 3-7 days and there were no adverse events post procedure such as bleeding or perforation. There were no stent migrations and stents were left in place for the rest of their life expectancy. One patient developed intermittent vomiting four weeks after stent deployment. This was possibly secondary to proximal stomach deployment, as repeated endoscopy showed a patent stent. The rest of the patients had clinical success and could tolerate diet on discharge. Range of follow up time was 1-6 months and at time of analysis GOO did not recur in all 5 patients. Three patients died due to disease progression with no symptoms of GOO prior to terminal event. EUS guided GJ is a novel procedure with favourable outcomes in patients with symptomatic GOO. Further prospective studies with larger number of patients are required to compare this new technique against the gold standard laparoscopic approach.

Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature.

The major symptoms of advanced hepatopancreatic-biliary cancer are biliary obstruction, pain and gastric outlet obstruction (GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decision-making must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation of the patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

Role of minimal invasive surgeries in gastric neoplastic diseases; how far we have come: an experience at tertiary centre

Background: Minimal invasive surgery (MIS) is a means of performing major operations through small incision, often using miniaturized, high tech imaging systems, to minimize the trauma of surgical exposure without compromising the quality of the surgical procedure. Upper gastro intestinal (GI) diseases constitute majority of gastro intestinal pathologies. With improved diagnostic and screening modalities, even in fatal diseases like carcinoma stomach (Ca stomach), MIS offers not only complete treatment but also improved quality of life by decreasing morbidity and mortality. This study attempts to explain our experience with MIS being performed at our institute.Methods: This study is hospital based, non-randomized prospective study carried out in the Department of Surgery, Govt. Cancer Hospital, Aurangabad from August 2014 to December 2016. Total 30 patients were included in study. All gastric neoplastic diseases operated by minimal invasive surgeries in patients of all age groups were included. All patients were operated under general anaesthesia. Post-operative pain scoring was done according to VAS scale. All patients were kept in ICU in immediate post-operative period for 2-3 days. Then patients were shifted to general ward once patients were clinically stable. Patients were discharged according to recovery. Hospital stay was prolonged in cases having complications. Patients were followed up post operatively after 1, 3 and 6 months and assessed on basis of symptoms.Results: Maximum patients belonged to the age group of 41-60 years. Mean age of patients operated for Gastrointestinal stromal tumours (GIST) was 57.5 years and Ca Stomach was 56.6 years. Mean operative time for laparoscopic gastrojejunostomy in our study was 150 min, for laparoscopic gastrectomy with gastro jejunal anastomosis was 230 min and for benign gastric tumours including GIST was 112 min. Type of anastomosis: Among 16 anastomoses, 2 oesophago - jejunal, 7 gastro - jejunal and 7 cases of gastro - gastric anastomosis were done. Jejuno - jejunal anastomoses are not included in this series. Both the oesophago - jejunal anastomoses were done by stapler method.Conclusions: It can be concluded that, minimal invasive surgeries for gastric diseases are feasible to perform. Blood loss, post-operative analgesia and hospital stay are less in laparoscopic procedures so it decreases over all hospital cost. Early post-operative recovery, decreased post-operative morbidity and avoiding unnecessary laparotomies are some of the other advantages of MIS. So, MIS should be considered as an alternative for open procedures in gastric disorders, for betterment of patient care.

Primary laparoscopic gastrojejunostomy tubes as a feeding modality in the pediatric population

PurposeOutcomes associated with primary laparoscopic gastrojejunal (GJ) tube placement in the pediatric population were evaluated. MethodsA single-institution, retrospective review examined patients undergoing laparoscopic GJ tube placement between June 2011 and December 2014. Outcomes included gastric feeding tolerance, subsequent fundoplication, complications, and mortality. ResultsNinety laparoscopic GJ tubes were placed. Median follow-up was 342days (interquartile range [IQR]=141–561days). Median patient age was 5months (IQR=3–11months) and weight was 5.2kg (IQR=4–8.4kg). The most common indications for placement were gastroesophageal reflux (n=85, 94.4%) and/or aspiration (n=40, 44.4%). Most common comorbidities included cardiac (n=34, 37.8%) and respiratory (n=29, 32.2%) diseases. The complication rate was 17.8%, including one case of intestinal perforation. Thirty-four (37.7%) patients transitioned to gastric feeding within 1year; time to conversion was 156days (IQR=117–210days); of those, 18.9% patients transitioned to oral feedings. A fundoplication was later performed in 4 children for persistent reflux. Mortality was 23.3% with no procedural-related deaths. ConclusionPrimary laparoscopically placed GJ tubes are a reliable means of enteral access for pediatric patients with gastric feeding intolerance. Many of these children are successfully transitioned to gastric and/or oral feedings over time. Further studies are needed to characterize which patients are best served with a GJ tube versus alternatives such as fundoplication. Level of evidenceIII (treatment) Type of studyRetrospective

Annular pancreas presenting as gastric outlet obstruction in an adult: a case report

Annular pancreas is a rare congenital abnormality which arises in the embryo by persistence of pancreatic tissue in the track which the ventral pancreatic bud follows in its rotation round the duodenum. A 21 years old male was admitted because of a non bilious vomiting and epigastric fullness after intake of food. Diagnosis was confirmed with contrast enhanced CT scan of the abdomen. He successfully underwent laparoscopic gastrojejunostomy with uneventful postoperative recovery. Though rare, annular pancreas should be considered as differential diagnosis in patient presenting as gastric outlet obstruction after excluding common causes.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 35-36

Laparoscopic Gastrojejunostomy for Patients with Unresectable Gastric Cancer with Gastric Outlet Obstruction

BackgroundThere have been no comparative studies of open gastrojejunostomy (OGJ) and laparoscopic gastrojejunostomy (LGJ) in gastric cancer (GC) patients with gastric outlet obstruction (GOO) to explore both short- and long-term outcomes. The aim of this study was to compare the safety and feasibility of short-term oral intake as well as the long-term oncological outcome of OGJ and LGJ. MethodsThis was a retrospective study of 53 consecutive unresectable GC patients who underwent GJ for GOO in our institute. OGJ (n = 23) was performed between 2010 and 2012 and LGJ (n = 30) was performed between 2013 and 2015. ResultsWe found a higher rate of postoperative delayed gastric emptying in the OGJ group than in the LGJ group (26.1 vs 0%; P = 0.004). OGJ had more unfavorable results regarding the median time to resumption of oral feeding (4 vs 2 days; P < 0.001). Palliative LGJ did not offer survival benefit over OGJ in patients with unresectable GC with GOO. ConclusionLGJ is a useful and feasible alternative to OGJ regarding short-term outcomes.

Radical resection of a primary unresectable duodenal cancer after chemotherapy using S-1 and cisplatin: report of a case

BackgroundTherapeutic outcomes and prognosis of primary unresectable duodenal cancer remains unsatisfactory, because effective chemotherapy is not established.Case presentationA 71-year-old male diagnosed with unresectable duodenal carcinoma with distant lymph node metastases was judged inoperable (cT3N2M1 cStage in UICC7th). Duodenal obstruction developed due to tumor growth, and the patient underwent laparoscopic gastro-jejunostomy and then combined chemotherapy using S-1 and cisplatin. Abdominal CT revealed reduction of the tumor, and lymph node swelling almost disappeared after chemotherapy.He underwent subtotal stomach-preserving pancreaticoduodenectomy and lymph node dissection including the para-aortic region. The final stage was fT3N1M0, StageIIIA in UICC7th. He developed pancreatic fistula (ISGPF grade B), which subsided, and he was discharged 29 days after operation. He underwent adjuvant chemotherapy using S-1 for 1 year, and he remains well without recurrence.ConclusionsS-1/cisplatin combination chemotherapy allowed R0 resection for advanced duodenal cancer.