43860 Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy

Name of the Procedure:

Revision of Gastrojejunal Anastomosis (Gastrojejunostomy) with Reconstruction, with or without Partial Gastrectomy or Intestine Resection; without Vagotomy.

Summary

This surgical procedure involves revising and reconstructing the connection (anastomosis) between the stomach and the jejunum (a part of the small intestine). It may include partial removal of the stomach or intestines. This procedure does not include cutting the vagus nerve (vagotomy).

Purpose

This surgery is performed to address complications related to the initial gastrojejunal anastomosis. It aims to correct problems such as blockages, ulcers, or leaks at the site of the original connection. The goal is to restore normal digestion and improve patient quality of life.

Indications

• Persistent or recurrent ulcers at the anastomosis site.
• Blockages or strictures preventing food passage.
• Leakage from the anastomosis causing infection or abscess.
• Severe reflux or bile vomiting.
• Poor nutrient absorption due to inadequate anastomosis.

Preparation

• Patients are usually instructed to fast for 8-12 hours before the procedure.
• Medications like blood thinners may need to be adjusted or halted prior to surgery.
• Diagnostic tests such as endoscopy, CT scans, or upper GI series may be required to assess the condition of the anastomosis and surrounding tissues.

Procedure Description

1. Anesthesia is administered; typically, general anesthesia is used.
2. An incision is made in the abdominal area to access the stomach and small intestine.
3. The current anastomosis is carefully examined.
4. Any scar tissue, blockages, or affected areas may be removed.
5. A new connection between the stomach and the jejunum is formed and secured.
6. If necessary, parts of the stomach or intestines may be resected.
7. The surgical site is checked for leaks and proper function.
8. The incision is closed with sutures or staples, and a dressing is applied.

Tools used may include surgical clamps, retractors, and anastomosis staplers.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the revision and reconstruction required.

Setting

The procedure is performed in a hospital operating room.

Personnel

A team of healthcare professionals is involved, including:

• Surgeons specializing in gastrointestinal surgery.
• Anesthesiologists.
• Surgical nurses and assistants.
• Possibly a surgical technician.

Risks and Complications

• Infection at the surgical site.
• Bleeding during or after the surgery.
• Leakage from the new anastomosis.
• Adverse reactions to anesthesia.
• Strictures or blockages at the new anastomosis.
• Nutritional deficiencies if significant portions of the stomach or intestines are removed.

Benefits

• Relief from symptoms such as pain, nausea, and vomiting.
• Improved digestion and nutrient absorption.
• Enhanced overall quality of life. Benefits may be noticed within a few days to weeks post-surgery, depending on individual recovery.

Recovery

• Patients may stay in the hospital for 5-7 days post-surgery.
• Gradual reintroduction to fluids and solid foods.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments for monitoring healing and any potential complications.

Alternatives

• Medical management with medications (e.g., proton pump inhibitors or antibiotics).
• Endoscopic dilation for strictures.
• Minimal invasive procedures if suitable. Alternatives may have less immediate risk but might not offer permanent relief, relying on medication or repeated interventions.

Patient Experience

Patients will be under general anesthesia during the surgery. Post-procedure, they may experience discomfort, which is managed with pain relief medications. Initial recovery will involve limited movement and gradual diet reintroduction. Full recovery can take several weeks, with ongoing improvements in symptoms and digestive function.