Palliative antecolic isoperistaltic gastrojejunostomy: a randomized controlled trial comparing open and laparoscopic approaches

Abstract

Gastric outlet obstruction is a common, often preterminal, event for patients with inoperable neoplasms of the distal stomach, duodenum, and biliopancreatic area. It can be surgically managed by open or laparoscopic gastrojejunostomy. This study aimed to compare the results of open and laparoscopic palliative gastrojejunostomy for patients with gastric outlet obstruction resulting from inoperable neoplasms. A total of 24 patients were randomized prospectively to undergo laparoscopic (12 patients) or open (12 patients) palliative laterolateral antecolic isoperistaltic gastrojejunostomy. All the procedures were completed as planned. The mean duration of surgery was not significantly different between the two groups (p = 0.75). The mean intraoperative blood loss was significantly less after laparoscopic gastrojejunostomy (LGJ) (p = 0.0001). Time to oral solid food intake was longer after open gastrojejunostomy (OGJ) (p = 0.04). Two patients in the OGJ group experienced postoperative delayed gastric empting, whereas no patients in the LGJ group experienced such a complication (p = 0.04). The mean postoperative stay was shorter in the LGJ group, but the difference did not reach statistical significance (p = 0.65). No readmissions were registered after a minimum follow-up period of 2 months. The findings show that LGJ is a safe, feasible, and effective alternative to OGJ. However, because the current data involved only a small number of patients, large studies still are required for further evaluation of the this operation's effectiveness.

A systematic review of methods to palliate malignant gastric outlet obstruction

“…When compared with OGJ, Jeurnink et al found that LGJ (33 OGJ versus 9 LGJ) appeared to be more favourable in terms of tolerating an oral intake, length of hospital stay and the rate of complications, but found no statistical difference between the two (Jeurnink SM, Personal communication, 2008). Navarra et al published a randomised controlled trial in 2005 comparing LGJ with OGJ in 24 patients (12 each) [21]. The study showed that LGJ resulted in significantly less intraoperative blood loss, shorter time to tolerating solid food intake and lower rate of complications, but no evidence of a difference in the hospital stay post-operatively.…”

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

“…Patients were also asked to describe ability to tolerate oral intake at baseline, 14 days, 1 month and 3 months after surgical palliation, based on the Gastric Outlet Obstruction Scoring System (GOOSS): 0, no oral intake; 1, liquids only; 2, soft solids; and 3, low‐residue or full diet18.…”

Laparoscopic perspectives for distal biliary obstruction

“…Several reports on laparoscopic palliation have been recently described, but only few of these compared open to laparoscopic gastrojejunal anastomosis [17,18]. In a retrospective cohort evaluation Guzman reported notable differences in terms of hospital stay between conventional and laparoscopic approaches, even if, given the small amount of patient in this series, any statistical evidence has been recorded [19,20].…”