Laparoscopic gastroenterostomy for duodenal obstruction*

https://doi.org/10.1016/S0002-9610(99)80213-XGet rights and content

Background

It is not yet clear where laparoscopic procedures will fit into the armamentarium of the surgeon. Over the past decade, there has been a clear trend toward minimally invasive procedures for palliation of inoperable cancer. Traditionally, when duodenal obstruction occurs secondary to a disease process, gastric bypass through laparotomy is required.

Patients and methods

Between November 13, 1992 and September 13, 1994, 10 patients underwent laparoscopic gastroenterostomy for duodenal obstruction. In 9 patients, the procedure was carried out for malignant obstruction; in 1 patient, duodenal obstruction was secondary to chronic scarring from benign peptic ulcer disease. Eight of these patients already had biliary decompression through radiologic or endoscopic means. One patient underwent laparoscopic cholecystenterostomy for biliary obstruction in addition to the laparoscopic gastroenterostomy.

Results

Laparoscopic gastroenterostomy was successfully completed in 8 of the 10 patients. In 2, conversion to open surgery was necessary. There was no mortality related to this operative approach.

Conclusions

Laparoscopic gastroenterostomy is a safe procedure for treatment of duodenal obstruction. Good palliation can be expected in patients with obstruction of the duodenum secondary to advanced malignancies.

References (13)

There are more references available in the full text version of this article.

Cited by (70)

  • Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients

    2007, Gastrointestinal Endoscopy
    Citation Excerpt :

    In comparison, open palliative surgery was associated with high mortality and morbidity rates (8%-33% and 20%-60%, respectively)16-20 and long length of hospital stay (14 days vs 4 days for stenting).21 Laparoscopic palliative surgery has recently been introduced as a minimally invasive surgical technique; however, it takes a long time to regain gut function postoperatively, and the need for surgical conversion is approximately 20%.22 These facts provide strong evidence favoring this form of nonsurgical palliative therapy in patients with unresectable malignant gastroduodenal obstruction.

  • Malignant Gastroenteric Obstruction: Therapeutic Options

    2007, Gastrointestinal Endoscopy Clinics of North America
    Citation Excerpt :

    The major shortcomings of surgical GEA, both open and laparoscopic, include significant rates of morbidity and mortality, which can be as high as 30% and 15%, respectively. In addition, postoperative ileus leading to hospital stays of 2 weeks or more and delayed gastric emptying can have a significant negative impact on the quality of life of individuals undergoing this procedure [2,9,10,13]. SEMS placement (using an esophageal stent) for palliation of malignant gastric outlet obstruction was first reported in 1992 by Truong and colleagues.

  • Minimally Invasive Treatment of Pancreatic Disease

    2007, Gastroenterology Clinics of North America
    Citation Excerpt :

    The safety and effectiveness of a laparoscopic stapled gastrojejunostomy has been shown in several series of patients with malignant gastric outlet obstruction, and in the vast experience with laparoscopic gastric bypass surgery. It should be considered together with endoluminal stenting as an alternative to an open surgical bypass procedure [30–35]. Finally, even among patients deemed not to be candidates for surgical resection by virtue of locally advanced disease found on routine imaging studies, laparoscopy may provide more accurate staging and determine whether systemic therapy should be administered alone or in combination with locoregional therapy [36,37].

View all citing articles on Scopus
*

Presented at the 81st Annual Meeting of the North Pacific Surgical Association, Coeur d'Alene, Idaho, November 10–11, 1994.

View full text