Vagotomy and Gastrojejunostomy for Benign Gastric Outlet Obstruction

ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction

This American Society for Gastrointestinal Endoscopy guideline provides evidence-based recommendations for the endoscopic management of gastric outlet obstruction (GOO). We applied the Grading of Recommendations, Assessment, Development and Evaluation methodology to address key clinical questions. These include the comparison of (1) surgical gastrojejunostomy to the placement of self-expandable metallic stents (SEMS) for malignant GOO, (2) covered versus uncovered SEMS for malignant GOO, and (3) endoscopic and surgical interventions for the management of benign GOO. Recommendations provided in this document were founded on the certainty of the evidence, balance of benefits and harms, considerations of patient and caregiver preferences, resource utilization, and cost-effectiveness.

Massive gastric dilation caused by gastric outlet obstruction in the setting of peptic ulcer disease-A case report

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Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer disease.

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We present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery due to perforation.

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We present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery.

Background

The prevalence of Peptic Ulcer Disease has decreased as did its elective surgical treatment, however its complications continue to occur.

Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer disease.

Case summary

In this report, we present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery due to perforation. A subtotal gastrectomy with a Billroth II reconstruction was performed.

Discussion

Usually non-operative management is tried first, with medical therapy and endoscopic dilation. Emergent surgery is rarely needed, but in this patient, despite trying to optimize his condition first, the ulcer perforation precipitated surgical management.

Conclusion

Although Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer Disease and usually non-operative treatment is tried first, surgery may be necessary.

Technical feasibility of laparoscopic Finney pyloroplasty examined in a canine model

The efficacy of laparoscopic surgery in the treatment of chronic duodenal ulcer has been demonstrated using minimally invasive approaches. This study aimed to evaluate the technical feasibility of laparoscopic Finney pyloroplasty in six dogs. Under laparoscopic guidance, the anastomosis was created using mechanical devices (n = 3) and combining a linear stapler device and intracorporeal suturing (n = 3). The operative time and complications were recorded. Evaluation of the anastomosis included studies of intraoperative and postoperative endoscopy and ultrasonography as well as the complete gastric emptying time. The animals were killed 4 weeks after surgery. Measurement of luminal diameter, amount of adhesion formation, degree of healing, and inflammation or fibrosis were evaluated in the postmortem studies. The operation was successfully completed for all the animals. No intraoperative or postoperative complications were observed. Gastric emptying was significantly enhanced in the postoperative period, as compared with the preoperative results. After 1 month, there was no evidence of anastomotic leak dehiscence at the gastroduodenal anastomosis. Luminal diameter was increased, and no abnormal findings were encountered during the postmortem abdominal exploration. The technical feasibility of performing a safe laparoscopic pyloroplasty in a dog model was demonstrated in this study.

Laparoscopy-assisted truncal vagotomy with antecolic posterior gastrojejunostomy for benign gastric outlet obstruction

BACKGROUND

The aim of this study is to highlight the role of minimally invasive surgery in the form of laparoscopy-assisted truncal vagotomy (TV) with ante-colic posterior gastrojejunostomy (PGJ) for benign gastric outlet obstruction (GOO). GOO is relatively common in southern India due to various factors. From 1994 to 2004, 762 patients with GOO were operated on (open TV with PGJ) in our center.

METHODS

From November 2003 to November 2004, 18 patients with GOO underwent the laparoscopic procedure in our unit. The procedure involves laparoscopic TV followed by the ante-colic PGJ performed extracorporeally through a 3.5-cm transverse incision in the upper abdomen.

RESULTS

The advantages of this procedure are that pain, hospital stay, size of wound, incidence of incisional hernia, and postoperative complications are reduced and the patient returns to work earlier. The results are comparable to those of a totally laparoscopic TV with PGJ.

CONCLUSION

This procedure is relatively easy to perform because the anastomosis is done extracorporeally, and it is less expensive than the use of endostaplers. Thus, more surgeons should be encouraged to perform laparoscopic TV with PGJ.