A gastrojejunostomy is a surgical procedure that creates a direct connection, called an anastomosis, between the stomach and the jejunum. This new pathway allows food to bypass the duodenum, the first section of the small intestine. This rerouting is necessary when a blockage or other problem prevents food and liquids from emptying from the stomach normally.
Conditions Requiring a Gastrojejunostomy
The most frequent reason for this procedure is gastric outlet obstruction (GOO), a blockage at the lower part of the stomach. GOO can result from several issues, including severe peptic ulcer disease where chronic inflammation and scarring narrow the passage.
Malignant tumors are another primary cause of such blockages. Cancers of the stomach, pancreas, or duodenum can grow and obstruct the digestive path. When a tumor cannot be surgically removed, a gastrojejunostomy can serve as a palliative measure to alleviate symptoms like persistent vomiting, abdominal pain, and malnutrition.
Other conditions can also necessitate this procedure. Severe inflammation, scarring, or trauma to the duodenum from causes like Crohn’s disease can lead to an obstruction. A preventative gastrojejunostomy may also be performed if a surgeon anticipates a high risk of future obstruction, such as from an advanced, inoperable pancreatic tumor.
How the Procedure Is Performed
A gastrojejunostomy can be performed using several surgical techniques. The traditional method is open surgery, which involves a single, large abdominal incision. This allows the surgeon to directly access the stomach and jejunum to create the new connection.
A more common approach is laparoscopic surgery, a minimally invasive technique using several small incisions. A laparoscope, a thin tube with a camera, provides a magnified view of the internal organs on a screen. The surgeon uses specialized instruments inserted through the other incisions to create the anastomosis. This approach typically results in less pain and a quicker recovery.
An even less invasive technique is the endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This procedure is performed internally using an endoscope passed down the throat into the stomach. Guided by ultrasound, the surgeon creates the anastomosis from inside the stomach and jejunum without external incisions. A special stent is often deployed to hold the new connection open, minimizing surgical trauma.
Life After a Gastrojejunostomy
Recovery requires a hospital stay for monitoring. Pain is managed with medication, and patients are not permitted to eat or drink at first to allow the new connection to heal. A nasogastric tube may be used for a few days to keep the stomach empty, while nutrition and hydration are supplied intravenously.
Reintroducing food is a gradual process managed by a dietitian, beginning with clear liquids. As tolerated, the diet advances to full liquids, then pureed and soft foods over four to six weeks. This progression helps the digestive system adapt before patients return to eating more solid foods.
Long-term dietary adjustments are necessary, as the rerouted stomach cannot handle large quantities of food. Patients are advised to eat six to eight small, frequent meals throughout the day. Eating slowly, chewing food thoroughly, and choosing nutrient-dense foods are important for avoiding discomfort and ensuring adequate nutrition.
Associated Complications and Management
A common issue after this surgery is dumping syndrome. This occurs when food, especially sugar, moves too rapidly from the stomach into the small intestine, causing nausea, cramping, and dizziness after eating. The condition is managed through dietary modifications like eating smaller meals, avoiding high-sugar foods, and sipping liquids between meals.
A rare but serious complication is an anastomotic leak, where the new connection leaks digestive fluids into the abdomen, which requires immediate medical attention. Over time, the connection can also narrow, a condition known as an anastomotic stricture. This may cause a blockage and require intervention to reopen it.
Another potential issue is the development of marginal ulcers, which are peptic ulcers that form in the jejunum near the anastomosis. This occurs because the jejunum is not equipped to handle high acid content directly from the stomach. These ulcers are often treated successfully with acid-reducing medications.