Laparoscopic Devine Exclusion Gastroenterostomy for the Palliation of Unresectable and Obstructing Gastric Carcinoma

Abstract

The Devine exclusion gastroenterostomy is an effective procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. We report on the successful laparoscopic application of this technique in two male patients aged 61 and 76 years with unresectable and obstructing antral gastric cancer. The operating time was 90 minutes for each patient, and the postoperative hospital stay was 3 and 4 days, respectively. There were no delays in gastric emptying and no recurrences of gastric outlet obstruction until the time of death, 3.5 and 9 months postoperatively, respectively. The laparoscopic approach to a Devine exclusion gastroenterostomy is a safe and effective minimally invasive approach to the palliation of unresectable obstructing gastric carcinoma.

Laparoscopic gastric bypass for gastric outlet obstruction is associated with smoother, faster recovery and shorter hospital stay compared with open surgery

“…The GJ was fashioned using either a hand‐sutured two‐layer technique or a combination of staples and sutures. The operative techniques of laparoscopic loop, Roux‐en‐Y, and exclusion gastric bypass have been described preciously …”

“…The operative techniques of laparoscopic loop, Roux-en-Y, and exclusion gastric bypass have been described preciously. [9][10][11][12]…”

Modified Devine Exclusion with Vertical Stomach Reconstruction for Gastric Outlet Obstruction: A Novel Technique

“…8-10 Laparoscopic Devine's procedure for the palliation of GOO has also been reported. [11][12][13] Therefore, considering the benefits of laparoscopic approach as a minimally invasive surgery, we also performed LMDVSR recently.…”

“…11 Ammori's procedure is an antecolic loop gastrojejunostomy performed after transection of the stomach 5 cm proximal to the obstructing antral tumor with the use of a stapler, and Braun's anastomosis is not performed. 12 Suzuki's procedure is an antecolic side-toside Roux-en-Y gastrojejunostomy after hemitransection (a 3-cm-wide segment near the lesser curvature is not transected), with side-to-side jejunojejunostomy. 13 However, transection of the stomach may prevent postoperative DRGE and hemorrhage of the tumor.…”

Laparoscopic-assisted Stomach-partitioning Gastrojejunostomy for the Palliation of Gastric Outlet Obstruction From Antral Gastric Cancer

“…Furthermore, Choi 11 reported that laparoscopic gastrojejunostomy also causes less suppression of immune function than open gastrojejunostomy. Other authors have previously reported, as a minimally invasive approach, laparoscopic Devine exclusion gastrojejunostomy for palliation of gastric outlet obstruction in antral gastric cancer 13 and for secondary to recurrent cholangiocarcinoma. 14 However, we consider that when using the Devine procedure it is not possible to observe antral tumors owing to the complete transection of the stomach.…”