43820 Gastrojejunostomy; without vagotomy

Name of the Procedure:

Gastrojejunostomy; without vagotomy

Summary

A gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum (a part of the small intestine), bypassing the duodenum. This procedure allows food to pass from the stomach into the jejunum more easily.

Purpose

Gastrojejunostomy is typically performed to treat blockages, severe peptic ulcers, or tumors in the upper gastrointestinal tract that prevent normal passage of food. The procedure aims to ensure that food can bypass the obstructed or affected areas, thereby improving digestion and nutritional intake.

Indications

• Obstructions in the stomach or duodenum due to tumors or strictures
• Severe peptic ulcers or complications such as perforation
• Conditions such as chronic pancreatitis where bypassing the duodenum is needed
• Recurrent gastric outlet obstruction

Preparation

• Fasting for at least 8 hours before surgery
• Stopping certain medications as advised by the physician
• Blood tests, imaging studies, or an endoscopy may be required to evaluate the condition of the gastrointestinal tract

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdominal wall to access the stomach and small intestine.
3. A portion of the jejunum is brought up and connected to an opening made in the side of the stomach, creating a new route for food to pass.
4. The connections are secured, and the abdominal incision is closed.

Tools/Equipment:

• Scalpel
• Surgical staples or sutures
• Anesthesia equipment

Duration

Typically, a gastrojejunostomy takes 1-3 hours, depending on the patient's condition and complexity of the surgery.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common risks:

• Infection
• Bleeding
• Anastomotic leakage (leakage at the connection site)
• Adverse reactions to anesthesia

Rare risks:

• Stricture formation at the anastomosis
• Nutritional deficiencies

Management:

• Antibiotics for infection
• Close monitoring and possible surgical intervention for leaks or bleeding

Benefits

• Relief from symptoms caused by obstructions
• Improved ability to eat and digest food
• Enhanced nutritional status

Recovery

• Hospital stay of 5-7 days
• Gradual reintroduction of oral intake starting with liquids, progressing to solid foods
• Pain management with prescribed medications
• Avoid strenuous activities for several weeks
• Follow-up appointments for monitoring recovery and nutritional status

Alternatives

• Endoscopic stenting: less invasive but may not be permanent
• Total gastrectomy: more extensive and usually reserved for severe cases
• Medications for symptom management: suitable for less severe cases, but not a definitive solution

Patient Experience

During the procedure:

• The patient will be under general anesthesia and will not feel any pain.

After the procedure:

• Some discomfort and pain managed with medications
• Gradual improvement in eating and digestion over a few weeks
• Regular follow-up is essential to monitor progress and address any complications.