Gastroenterostomy- Indications and Contraindications

What Is Gastroenterostomy?

Gastroenterostomy is a surgical procedure that is performed as an anastomosis created between the stomach and the proximal loop of the jejunum. It is done to drain the contents of the stomach by creating a bypass for gastric contents. This procedure can be performed either by an open approach or a laparoscopic approach. A percutaneous approach is made, in which a long flexible tube is placed through the abdominal wall to the stomach and then the jejunum. The article below describes briefs about gastroenterostomy techniques, indications, and complications.

What Are the Diseased Conditions Indicated for Gastroenterostomy?

The diseased conditions indicated are:

Malignant diseases:

• Lymph node metastasis: Metastatic condition that occurs on lymph nodes and infects cancer from other parts of the body

• Gallbladder cancer: Abnormal growth of cells in the gallbladder leading to gallbladder cancer.

• Pancreatic cancer: Abnormal growth of pancreatic cells.

• Bile duct cancer.

• Duodenal cancer.

• Gastric cancer.

• Ampullary cancer.

Benign diseases:

• Chronic pancreatitis: It is a progressive inflammatory disorder that leads to the irreversible destruction of endocrine and exocrine pancreatic parenchyma caused by atrophy and replacement with fibrotic tissue.

• Acute pancreatitis.

• Duodenal ulcer.

• Gastric ulcer.

• Superior Mesenteric Syndrome: A rare disease that is defined as compression of the third portion of the duodenum between a superior mesenteric artery and the abdominal aorta.

• Surgical Anastomosis Stricture: After gastric bypass surgery for weight loss, the new connection between the stomach pouch and small intestine may narrow. This is called anastomotic stenosis.

• Post-endoscopic therapy.

What Are the Indications of Gastroenterostomy?

The most common indication for gastroenterostomy is gastric outlet obstruction (GOO). Other conditions indicated are as follows:

• A pre-pyloric ulcer with pyloric scarring.

• Truncal vagotomy with gastroenterostomy.

• In chronic gastric ulcers after a gastrectomy.

• In cases of suspicious malignancy in gastric ulcers.

• An alternative procedure to Billroth I gastrectomy.

• For resectable carcinoma of the anthropologic region.

• It is indicated as a palliative treatment in cases of non-resectable malignancies of the duodenum, pancreatic head with gastric outlet obstruction, and stomach.

• In morbid obesity individuals with malabsorption, a roux-en-y gastroenterostomy is performed as a restrictive procedure.

• In cases where individuals are not responsive to medical management, percutaneous gastrostomy, along with gastroenterostomy, is done to relieve symptoms.

What Are the Contraindications of Gastroenterostomy?

The contraindications of gastroenterostomy are mainly the individuals who are unfit to take general anesthesia. Other relative contraindications include the following:

• Individuals with diffuse peritonitis and severe sepsis.

• Extensive gastric varices.

• Condition in which an increased risk of anastomotic leakage is present.

• Laparoscopic approach with a past history of surgeries in the upper abdomen.

What Preparations Are Done Prior to a Gastroenterostomy?

A preoperative evaluation is done, followed by several medical tests and imaging tests, like,

• Blood analysis.

• Endoscopy.

• CT scan (computed tomography).

• Upper gastrointestinal contrast study.

• Pregnancy test (done in cases of doubt).

What Instructions Are to Be Followed Before the Procedure of Gastroenterostomy?

Prior to the procedure, a few instructions are given by the healthcare provider which needs to be followed :

• Stop smoking.

• Share all the medications list taken by the individual and all the over-the-counter medication lists.

• Avoiding intake of blood thinners if taken.

• Fasting after midnight to the day before the surgery. This helps in preventing the risk of vomiting during the procedure.

• A family member or friend is accompanied to drive back home after the procedure.

How Is Gastroenterostomy Done?

The individual is mostly admitted a day prior to the procedure to keep a check on vitals and make the individual pre-ready for the procedure. Essential fluids and electrolytes are recommended and supplied in cases of any imbalances. During the procedure

• The individual is laid back on the bed with arms spread out, and an anesthesiologist administers anesthesia.

• A tube is then inserted in the bladder to drain any urine leak during the surgery followed.

• Antibiotics are administered to prevent infection.

• An incision is made over the midline of the abdomen that extends from the rib cage to the lower abdomen.

• The affected part of the stomach is removed, and the intestine is then stitched with the remnant part of the stomach, and the original opening of the stomach is stitched back to the jejunum.

Laparoscopic Approach: Laparoscopic approach is made by making small tiny incisions on the abdomen. Laparoscopic instruments are then inserted, a small tube with a camera and light head that gives proper access to the surgery site. Compared with conventional methods, the laparoscopic approach is more convenient for patients due to a faster recovery rate, shorter hospital stay, minimal surgical invasion, and less pain and scarring.

What Happens After the Procedure of Gastroenterostomy?

After the surgery, when the individual regains consciousness, they may feel groggy and tired and may experience sore throat, restlessness, and dry mouth. In most cases, the effects of anesthesia take a few hours to fade. Painkillers and antibiotics are provided to relieve postoperative pain. Special support stockings are provided to prevent blood clot formation in the legs.

What Are the Possible Complications of Gastroenterostomy?

The possible complications with gastroenterostomy are:

• Skin infections.

• Peritonitis.

• Risk of anesthesia like confusion, stroke, and heart attack.

How to Take Care After the Procedure of Gastroenterostomy?

The following steps should be followed and taken care of after the procedure:

• Keep the wound area clean and dry.

• Ask the healthcare provider regarding when and how the showers should be taken and done.

• Avoid rubbing hard or scratching near or on the incisions.

• Placing a pillow against the incision while coughing or sneezing can reduce pressure on them.

• Take regularly prescribed medications like painkillers, antibiotics, and stool softeners.

• Take lots of fluids and a fiber-rich diet.

• Avoid vigorous exercise and lifting heavy objects.

• If there are any signs of persistent pain, fever, difficulty in breathing, bleeding, foul-smelling discharge, blood in urine, or skin rash, contact the concerned provider immediately.

Conclusion

Though gastroenterostomy is a widely known and performed procedure, it has a few limitations to overcome. This procedure is still used to treat conditions like gastroparesis that are refractory to other treatments. Rarely used to treat peptic ulcers. It is usually performed as a part of an operation, which is done along with a partial gastrectomy. Endoscopic-guided gastroenterostomy is an emerging potential treatment for benign disease, gastric outlet obstruction, and many malignant conditions with fewer adverse effects.