Name of the Procedure:

Revision of Gastroduodenal Anastomosis (Gastroduodenostomy) with Reconstruction; without Vagotomy

Summary

A revision of gastroduodenal anastomosis involves surgically altering the connection between the stomach and the duodenum. This is done to correct or improve a previous gastroduodenal connection (gastroduodenostomy) without cutting the vagus nerve (vagotomy).

Purpose

This procedure is performed to address problems such as ulcers, blockages, or complications from a previous surgery. The goal is to restore proper digestion and alleviate symptoms like pain, nausea, and vomiting.

Indications

• Persistent or recurrent peptic ulcers
• Gastric outlet obstruction
• Persistent or recurrent gastrointestinal bleeding
• Complications from a previous gastroduodenostomy (e.g., leakage or stricture)

Preparation

• Fasting for at least 8 hours before surgery
• Adjustments to current medications as directed by the surgeon
• Blood tests, imaging studies, and endoscopic evaluations may be required

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the abdomen to access the stomach and duodenum.
3. The current gastroduodenal anastomosis is identified and carefully dissected.
4. Reconstruction involves creating a new connection between the stomach and duodenum, ensuring there are no blockages or leaks.
5. The surgical site is thoroughly checked for bleeding or other issues before closing the incision with sutures or staples.

Duration

The procedure typically takes 2-4 hours to complete, depending on the complexity.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Surgeon
• Surgical assistant
• Anesthesiologist
• Scrub nurse
• Circulating nurse

Risks and Complications

• Infection
• Bleeding
• Leakage from the new anastomosis
• Stomach or duodenum injury
• Potential need for further surgeries
• Risks associated with general anesthesia

Benefits

Successful revision can restore normal digestive function, alleviate painful symptoms, and improve the patient's quality of life. Patients may begin to notice benefits within a few days to weeks post-surgery.

Recovery

• Hospital stay of approximately 5-7 days
• Gradual reintroduction of food and liquids
• Pain management may involve medications
• Follow-up appointments required for monitoring and possible removal of sutures or staples
• Complete recovery may take several weeks

Alternatives

• Endoscopic dilation of strictures
• Medications to manage ulcers or other gastrointestinal issues
• Total gastrectomy in severe cases
• Each alternative has its own risks and benefits which should be discussed with the physician

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, some discomfort and pain is expected but will be managed with medication. The patient might experience dietary adjustments and activity restrictions during the recovery period. Special attention will be given to wound care and monitoring for complications such as infection or leakage.