Stomach-partitioning Gastrojejunostomy Research Articles

Laparoscopic stomach‐partitioning gastrojejunostomy is an effective palliative procedure to improve quality of life in patients with malignant gastroduodenal outlet obstruction

A patient with gastroduodenal obstruction caused by an unresectable gastroduodenal or periampullary cancer cannot ingest food and/or liquid. The patient's quality of life rapidly deteriorates, resulting in a dismal prognosis. Stomach-partitioning gastrojejunostomy has been previously reported, and here, we evaluate the laparoscopic procedure. We performed laparoscopic stomach-partitioning gastrojejunostomy in 18 patients with unresectable gastroduodenal or periampullary cancers. Data on operation time, blood loss, complications, and postoperative course were retrospectively collected. The mean operation time was 152 min, and conversion to open surgery was not required in any patients. Postoperative complications occurred in three patients (17%) and included cholangitis, anastomotic ulcer hemorrhage, and enterocolitis. The mean time to oral intake was 4.5 days, and the mean and median duration of oral intake were maintained for 133 and 88 days, respectively. Laparoscopic stomach-partitioning gastrojejunostomy is a safe and effective procedure that allows patients with gastroduodenal outlet obstruction to eat again and improve the quality of their remaining life.

Partial Stomach-Partitioning Gastrojejunostomy (PSPG) and the Success of This Procedure in Terms of Palliation

Partial Stomach-Partitioning Gastrojejunostomy (PSPG) and the Success of This Procedure in Terms of Palliation

A technical surgery for refractory gastroparesis in a patient with a mitochondrial disorder

Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Gastroparesis has been associated with various diseases and may occur as part of a mitochondrial disorder. In a patient with pyruvate dehydrogenase complex deficiency, which is associated with abnormal mitochondrial metabolism, intragastric liquids were retained massively and gastroparesis was diagnosed by demonstrating delayed gastric emptying. For an atonic stomach with impaired fundic distention, partial gastric plication, modified stomach-partitioning gastrojejunostomy using the stapled gastrectomy with Braun's anastomosis, antireflux gastroplasty with stapled wedge, and re-gastrostomy were performed. After operation, intragastric liquids were reduced remarkably and delayed gastric emptying was improved. She was doing well and discharged uneventfully. Our technical surgery reported improvement in delayed gastric emptying and we confirm the benefits of this operation.

Laparoscopic-assisted Stomach-partitioning Gastrojejunostomy for the Palliation of Gastric Outlet Obstruction From Antral Gastric Cancer

Conventional gastrojejunostomy is performed for gastric outlet obstruction; however, we have experience of some patients for whom oral intake was not adequately restored. Open stomach-partitioning gastrojejunostomy is a useful technique for the relief of unresectable and obstructing antral gastric cancers. We herein report the successful laparoscopic application of this technique in 2 patients: a 62-year-old male and a 65-year-old female with obstructing antral gastric cancer. There were no operative complications, and blood loss was minimal. Oral fluid intake was resumed 3 and 4 days postoperatively. Chemotherapy by oral administration was possible for each patient. There was no recurrence of the gastric outlet obstruction in either patient up until they died 6 and 10 months after surgery. Laparoscopic stomach-partitioning gastrojejunostomy is a safe and useful technique for treating unresectable and obstructing antral gastric cancer, allowing the possibility of adequate oral intake and permitting the administration of anticancer drugs.

Stomach-Partitioning Gastrojejunostomy for Gastroduodenal Outlet Obstruction

The outcome of the stomach-partitioning gastrojejunostomy (SPGJ) procedure is superior to that of stenting procedures. Data from patients who underwent an SPGJ were collected retrospectively from hospital medical records (body weight, hemoglobin and albumin levels, assessment of food intake, duration of hospitalization, complications, and survival rates), and we compared the results with those obtained from patients treated with stenting. Departments of Gastrointestinal Surgery and Gastroenterology, Tokyo University Hospital, Tokyo, Japan. A series of 16 consecutive patients with gastroduodenal outlet obstruction who underwent an SPGJ and 9 patients who were treated with stenting between January 5, 1998, and August 18, 2004. Mann-Whitney, Fisher exact, and generalized Wilcoxon tests were used for statistical analyses. There were no differences between the 2 groups concerning background data, physiological status, or laboratory data. The starting point of food intake by patients treated with stenting was significantly earlier (at 4.2 days in the stent group vs at 6.0 days in the SPGJ group, P < .004). The numbers of patients taking a regular meal at 2 weeks after treatment were 12 of 16 patients in the SPGJ group and 1 of 9 patients in the stent group (P < .001). There was no significant difference between the 2 groups regarding the duration of hospitalization. The complication rates were significantly different between the 2 groups (P = .48). The median survival was 7.3 months in the SPGJ group and 2.8 months in the stent group (P = .008), and the mean 6-month survival rates were 81% (13 of 16) and 33% (3 of 9), respectively (P < .04). Stomach-partitioning gastrojejunostomy achieved improved quality of life and a better prognosis compared with stenting procedures, and it is the treatment of choice for gastroduodenal outlet obstruction.

Partial stomach-partitioning gastrojejunostomy for malignant duodenal obstruction

Background Standard methods of palliative gastrojejunostomy lead to delayed gastric emptying in up to 67% of patients. Partial stomach-partitioning gastrojejunostomy (PSPG) allows for the preferential passage of ingested material into the jejunum while maintaining endoscopic access to the diseased region and obviating the risk of leakage after antrectomy. Methods A retrospective examination of all patients undergoing PSPG from February 1999 through November 2004 was undertaken. Successful palliative bypass was based on the patient’s ability to tolerate a regular diet. Results Thirty-nine patients underwent PSPG during the study period. All patients had locally advanced or metastatic gastrointestinal tract tumors. Sixteen patients presented with obstructive symptoms. The majority of patients (97%) were tolerating a regular diet at their last follow-up. Conclusions PSPG is an alternative method of providing palliative bypass and allows for excellent palliation with delayed gastric emptying rates lower than that of standard gastrojejunostomy procedures.

Stomach-partitioning gastrojejunostomy for unresectable gastric carcinoma.

To analyze the results of a new type of bypass procedure, stomach-partitioning gastrojejunostomy (SPGJ), for unresectable gastric carcinoma and to compare these results with those of conventional gastrojejunostomy (GJ). Retrospective review. A university hospital in Japan. Eight patients underwent SPGJ in 1 group, and 13 underwent conventional GJ in the other group. Staging was determined using preoperative diagnostic imagings and intraoperative findings. Assessment of food intake and mean survival rates. There were no significant differences between the 2 groups regarding male-female ratio, mean age, and histological type of carcinoma. All patients had stage IV cancers according to the classification of the Union Internationale Contre le Cancer. The rates of taking a regular meal at 2 weeks after an operation were 88% in the SPGJ group and 31% in the GJ group (P < .05). The mean 1-year survival rates for SPGJ and GJ groups were 42.9% and 7.7%, respectively (P < .05). The mean survival times were 13.4 months in the SPGJ group and 5.8 months in the GJ group (P < .05). Stomach-partitioning gastrojejunostomy achieved an improved quality of life and a better prognosis for patients, and it is the preferred bypass procedure for unresectable gastric carcinoma.