Laparoscopic Stapled Gastrojejunostomy in Non-operable Cases of Malignant Gastric Outlet Obstruction (GOO): A Retrospective Study

Abstract

Background: Inability of gastric contents to go beyond the proximal duodenum is termed as gastric outlet obstruction (GOO). This may be partial or complete. A multitude of causes, benign/malignant, may lead to GOO of gastric and extra gastric origins. Malignant GOO is a common condition among locally advanced gastric cancer patients. One of the relative contraindications for surgery is the presence of advanced malignancy; in these cases, in which life expectancy may be limited to a few months, palliative surgical measures may improve the quality of life. The role of the laparoscopic approach in the treatment of GOO is under investigation and may represent a valid form of therapy with low morbidity. Materials and methods: This was a retrospective study conducted in the Department of General Surgery, Government Medical College, Srinagar, from May 2018 to May 2019. A total of 35 patients who were diagnosed as cases of non-operable malignant GOO were included in the study. All patients underwent laparoscopic stapled gastrojejunostomy after diagnostic laparoscopy. This study was aimed at operative time, time for making anastomosis, hospital stay, return of bowel sounds, and postoperative complications. Results: Mean age of patients in our study was 66.8 years with male predominance. Mean operative time was 94.35 minutes with a mean time of 20.4 minutes for making stapled anastomosis. Mean hospital stay, return of bowel sounds, and resumption of orals were 7.9, 2.28, and 3.85 days, respectively. Bleeding from the anastomotic site was noted in three patients and anastomotic leak was noted in one patient. Conclusion: Laparoscopic stapled gastrojejunostomy is a viable option for palliation in advanced cases of non-operable malignancies leading to GOO. It is associated with less operative times and less immediate postoperative complications. However, further studies are needed before laparoscopic stapled gastrojejunostomy is taken up as a standard for non-operable cases of malignant GOO.