What Is a Gastrojejunostomy?

For anastomotic anastomosis of the colon and stomach. It is suitable for patients with unresectable gastric pyloric tumor, gastric ulcer caused by pyloric obstruction, duodenal ulcer complicated by pyloric obstruction and cannot tolerate major gastrectomy. This operation is simple and takes less time.

Gastrojejunostomy

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For anastomotic anastomosis of the colon and stomach. It is suitable for patients with unresectable gastric pyloric tumor, gastric ulcer caused by pyloric obstruction, duodenal ulcer complicated by pyloric obstruction and cannot tolerate major gastrectomy. This operation is simple and takes less time.

Chinese name

Gastrojejunostomy

Department

Internal medicine

nickname

Anterior colonic jejunostomy

Operation

Easy to operate and takes less time

Pay attention

Local anesthesia is available for poor patients

For anastomotic anastomosis of the colon and stomach. This operation is simple and short, and is suitable for patients with unresectable gastric pyloric tumors and patients with ulcerative pyloric obstruction who cannot tolerate resection.

1. Pyloric obstruction caused by gastric cancer, and the tumor has been fixed, and those who cannot be removed can be used for gastric jejunostomy to relieve the obstruction.

2. Gastric ulcers cause pyloric obstruction, and are seriously ill. They cannot tolerate partial gastrectomy, and because these patients have low gastric acid, they can be used for gastric jejunostomy.

3. Duodenal ulcer with pyloric obstruction, the patient is in poor condition, and can not tolerate major gastrectomy, can perform gastric vagus nerve cut to reduce gastric acid, and also add gastric drainage (such as pyloroplasty, gastric Duodenum or gastrojejunostomy) to relieve retention of gastric contents.

1. In patients with pyloric obstruction, because the contents of the stomach are retained, the bacteria are prone to multiply, causing congestion and edema of the mucosa, which hinders the healing of the anastomosis after surgery. Fasting should be performed before surgery, gastric lavage the night before surgery to make the stomach empty as much as possible to reduce inflammation.

2. Should be appropriate fluid replacement, blood transfusion, and correct water and electrolyte imbalance.

3. The gastric contents should be evacuated before entering the operating room to avoid vomiting during anesthesia, which may cause suffocation and pulmonary complications.

Local anesthesia can be used for patients in poor condition, general anesthesia can be used for mentally stressed or severe gastric retention, and epidural anesthesia can be used for young and adult abdominal muscle tension.

1. Posture, incision supine, midline incision in the upper abdomen or rectus incision in the left upper quadrant.

2. Choosing the jejunal anastomosis section to make a laparotomy to determine that the patient is suitable for gastric jejunostomy. First, lift the transverse colon and find the duodenal suspensory ligament along the mesentery of the transverse colon to confirm the beginning of the jejunum. Select a section of jejunum, and at two points 15 and 20 cm from the duodenal suspensory ligament, use the silk thread to sew a needle in the intestinal plasmamuscular layer for anastomosis.

3. Suspension of the mesentery space tightens the mesentery and jejunum, and the two layers of mesangium are sutured intermittently with a silk thread from the base to the intestine, and the mesangial space is closed to prevent internal hernia.

4. Anterior gastric wall anastomotic ulcer disease and pyloric obstruction are selected. The anastomosis site can be selected across the vertical line of the pyloric notch near the anterior wall of the stomach. For gastric pyloric tumors, the anastomosis site should be as far away from the tumor as possible to avoid tumor invasion in the short term after operation and cause obstruction. After the anastomosis site is selected, the jejunum with the suture mark is lifted from the front of the colon, and moves along the long axis along the long axis in the direction of the intended anastomosis (that is, the proximal end is on the left side and the distal end is on the right side). The jejunum crest prepares anastomosis (approximately 5-6 cm in length) at both ends of the mesangial surface and the gastric wall to sew a serous muscle layer traction line. After knotting, the traction line is prepared for anastomosis.

5. The outer layer of the posterior wall of the anastomotic suture is covered with gauze around the anastomotic site and the back side to prevent contamination of the abdominal cavity. First, use silk thread to stomach the stomach and intestine (outer wall of the anastomosis) as a row of serous muscle layers for intermittent (or continuous) suture.

6. Cut the stomach and intestinal wall, suture the anastomosis posterior wall of the anastomosis 0.5 cm along the sides of the suture. Cut the stomach and intestinal wall into the muscular layer of the intestine, and suture submucosal blood vessels (preferably with a little plasma muscular layer to avoid cutting After opening, the mucosal layer is excessively turned out), then cut the stomach and intestinal mucosa, and use the suction device to suck up the contents of the stomach and intestine. Starting from the distal corner, suture the inner wall of the anastomosis. First enter the needle through the intestinal cavity with the No. 1 intestine thread, penetrate the gastric cavity, and then return from the gastric cavity to the intestinal cavity. , Knot in the cavity, do not cut the thread ends. Use the same line to sew all the back walls. The side distance is about 0.5cm, the stitch distance is about 0.8cm, and it is sewn to the proximal angle, and the proximal angle is completely inverted.

7. The inner layer of the anastomosis anastomosis continues to use the same line along the anterior wall to switch to a full-layer continuous inversion mattress suture (Commell), loop back to the beginning of the suture, and tie the ends of the intestinal line in the cavity. At this point, the inner layer of the front wall is sutured.

8. After suture anastomosis, the outer wall of the anastomotic wall was sutured with silk sutures, and the two corners of the anastomosis were reinforced with a serous muscle layer 8 or mattress suture. After the anastomosis is completed, check again whether the intestinal loop after anastomosis is a jejunum, whether the length is appropriate, and whether it is distorted. Then, remove the gauze pads around the anastomosis and the back wall, wash your hands or change gloves after surgery, and use your fingers to detect the size of the anastomosis outside the stomach and intestinal wall. The anastomotic opening should be able to pass 3 fingers, and the jejunal loop input and output ports can each pass the thumb. Finally, the abdominal cavity was examined, and the abdominal wall incision was sutured layer by layer.

1. The anterior colonic jejunostomy anastomosis (ie, the proximal jejunum of the anastomotic stoma) should be of appropriate length, generally 15 to 20 cm from the duodenal suspension ligament. Because the input ridges must go around the anterior wall of the transverse colon and the greater omentum to conform to the anterior gastric wall. If the input ridges are too short, they will cause the retention of bile, pancreatic juice and intestinal fluid. If they are too long, food will stagnate in the input ridges.

2. The length of the anastomosis is generally 4 to 6 cm. Obstruction is often caused by congestion and edema after too small surgery, and excessive emptying may cause symptoms of accelerated food emptying.

3. The submucosal vessels of the stomach and intestinal wall of the anastomosis should be sutured, which plays an important role in preventing postoperative anastomotic bleeding.

4. When the full-layer continuous inversion mattress suture anastomosis, it is necessary to pay attention to the uniform margin and needle pitch. Generally, the edge margin is 0.5cm and the needle pitch is about 0.8cm. hole.

1. Fasting was continued after the operation, and the gastric tube was kept decompressed for 1 to 2 days. After the intestinal motility was restored, the liquid diet could be entered.

2. Rehydration continues during fasting and blood transfusions if necessary.

3. Patients with a relatively healthy physique do not need lower stomach tubes and fasting after surgery, and they are advised to eat early.