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Gastroenterostomy for Pyloric Obstruction

Last updated May 4, 2018

Gastroenterostomy for Pyloric Obstruction is a surgical procedure that creates an alternate outlet in which the bottom part of the stomach is opened and connected to the small intestine.


Background Information:

What are the other Names for the Procedure?

  • Gastro Jejunostomy
  • GJ Anastomosis

What is Gastroenterostomy for Pyloric Obstruction surgical procedure?

  • Pylorus is the distal most (away from the origin point) portion of the stomach. An obstruction can occur at the pylorus, secondary to an ulcer-related stricture; or due to an increased thickening of the pylorus muscle, or due to a tumor (benign or malignant)
  • Gastroenterostomy for Pyloric Obstruction is a surgical procedure that creates an alternate outlet in which the bottom part of the stomach is opened and connected to the small intestine. This technique avoids an obstructed passageway, which is caused by an ulcer scar tissue (or due to other reasons), by creating a new one

What part of the Body does the Procedure involve?

Gastroenterostomy for Pyloric Obstruction procedure involves the stomach, duodenum, and usually the jejunum (small intestine part).

Why is the Gastroenterostomy for Pyloric Obstruction surgical procedure Performed?

A Gastroenterostomy for Pyloric Obstruction surgical procedure is performed to restore the normal function of the gastrointestinal tract.

What are some Alternative Choices for the Procedure?

Laparoscopic gastro jejunostomy is an alternative choice to bypass the pyloric obstruction.

What are the Recent Advances in the Procedure?

Laparoscopic Gastro Jejunostomy is a recent advance, in which:

  • Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen, in the area of the belly button
  • A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs, on a television screen
  • Other cannulas are inserted, which allow the surgeon to  connect the stomach and  the jejunum
  • The advantages of laparoscopic surgery  include: Tiny incisions, less post-operative pain, faster recovery, and earlier return to routine/regular activity

What is the Cost of performing the Gastroenterostomy for Pyloric Obstruction surgical procedure?

The cost of Gastroenterostomy for Pyloric Obstruction procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Gastroenterostomy for Pyloric Obstruction surgical procedure and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.laparoscopicexperts.com/laparoscopic_gastrojejunostomy.html

http://www.laparoscopicexperts.com/laparoscopic_gastrojejunostomy.html

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Gastroenterostomy for Pyloric Obstruction surgical procedure:

How is the Gastroenterostomy for Pyloric Obstruction surgical procedure Performed?

The Gastroenterostomy for Pyloric Obstruction surgical procedure is performed as:

  • A vertical midline skin incision is made on the upper portion of the abdomen
  • Abdominal cavity is entered by cutting through all the layers of the abdominal wall
  • The stomach is identified and a small opening is made, above the level of pyloric obstruction
  • Small opening is made on the mid-portion of the jejunum and the two openings are connected with stapler or sutures
  • The abdomen is then closed in layers, with sutures

Where is the Procedure Performed?

A Gastroenterostomy for Pyloric Obstruction procedure is performed at a hospital.

Who Performs the Procedure?

A physician trained in general surgery performs the Gastroenterostomy for Pyloric Obstruction procedure.

How long will the Procedure take?

The procedure typically takes about 1-2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
  • A physician will request your consent for Gastroenterostomy for Pyloric Obstruction procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Gastroenterostomy for Pyloric Obstruction procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Gastroenterostomy for Pyloric Obstruction surgical procedure?

The individual has to undergo certain tests prior to a Gastroenterostomy for Pyloric Obstruction procedure, such as:

  • Routine blood and urine analysis
  • Esophago Gastro Duodenoscopy (EGD)
  • X-rays of upper gastrointestinal tract
  • Serum electrolytes

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Gastroenterostomy for Pyloric Obstruction procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • What are the alternatives to the procedure?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Gastroenterostomy for Pyloric Obstruction surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered during the procedure.

How much Blood will you lose, during the Procedure?

The blood loss during the surgery is generally minimal, unless any complications arise.

What are the possible Risks and Complications during the Gastroenterostomy for Pyloric Obstruction surgical procedure?

There are general factors that increase the risk of getting complications during the surgery, which include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Infection surrounding the surgical would
  • Bowel leakage inside the abdomen
  • Formation of blood clots
  • Anesthetic complications
  • Accidental injury to the neighboring tissues

What Post-Operative Care is needed at the Healthcare Facility after the Gastroenterostomy for Pyloric Obstruction surgical procedure?

  • After the surgical procedure, the patients will be sent to an area of the hospital, called the postoperative recovery area (PACU)
  • The patient’s vital signs (blood pressure, heart rate, and respiration) are monitored for a short period of time, and is then transferred to the inpatient floor
  • The individual is discharged from the hospital when he/she is able to tolerate oral diet, passes flatus and/or bowel movement, is able to ambulate without any (or with minimal) assistance, and the pain is under control with oral pain medications

After the Gastroenterostomy for Pyloric Obstruction surgical procedure:

What are the possible Risks and Complications after the Gastroenterostomy for Pyloric Obstruction surgical procedure?

Post Gastroenterostomy for Pyloric Obstruction surgical procedure, the following complications may arise:

  • Excessive bleeding
  • Slow digestion of food
  • Signs of an infection
  • Incisional hernia
  • Narrowing at the level of the connection
  • Ulcer at the level of connection

What is the Prognosis after the Surgery?

The prognosis is usually excellent, and a complete recovery from a Gastroenterostomy for Pyloric Obstruction procedure without any complications, is expected.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling around the surgical wound
  • The occurrence of any symptom that causes uneasiness, such as nausea and vomiting
  • Signs of infection
  • Fever
  • Dizziness
  • Feeling sick
  • Muscle aches
  • Headaches
  • Complications associated with prescription medications used for the treatment

What Post-Operative Care is needed at Home after Gastroenterostomy for Pyloric Obstruction surgical procedure?

At home, the following post-operative care is recommended after a Gastroenterostomy for Pyloric Obstruction procedure:

  • Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
  • Avoid all activities that are physically strenuous, for about 6 weeks after surgery
  • Use a heat pad or warm compress on the incision, to relieve pain
  • Keep the wound clean and dry
  • Avoid taking baths, until the surgical wound is completely healed
  • Replace the dressing on the surgical wound, or remove it (as advised by the physician)
  • When resting, keep the legs in an elevated position, to reduce possibility of deep-vein blood clots
  • Complete the course of prescribed medication
  • Take stool softeners to prevent constipation
  • Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if required
  • Resume driving, only a month after leaving the hospital
  • Avoid sex till complete healing has taken place (under advise by the physician)
  • Avoid smoking

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 6 weeks to fully recover from this procedure

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient

Who will you receive a Bill from, after the Gastroenterostomy for Pyloric Obstruction surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility, physician’s office or hospital
  • An anesthesiologist (if anesthesia was administered)
  • A general surgeon

The patient is advised to inquire and confirm the type of billing, before the Gastroenterostomy for Pyloric Obstruction procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 17, 2013
Last updated: May 4, 2018

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