Loop Gastrojejunostomy

Laparoscopic gastrojejunostomy (LGJ) has been proposed as the technique preferred over open gastrojejunostomy for relieving gastric outlet obstruction (GOO) due to malignant and benign disease. After placement of trocars, the greater curvature of the stomach was identified. The majority of the surgeries were antecolic GJ, given the increased risk for internal hernia with retrocolic GJ. The gastrocolic omentum was opened using a (brand hidden). The lesser sac was entered, and the distal stomach was identified. The position on the distal stomach for creation of the GJ was based on surgeon's preference. A loop of small bowel approximately 30cm to 50cm distal to the ligament of Treitz was chosen for the gastrojejunostomy. A laparoscopic stay suture was used to align the small bowel segment in an antecolic manner to the anterior or posterior wall of the stomach. Enterotomies were then made with cautery in both the jejunum and stomach. One to two staplers were used to create the anastomosis. The common enterotomy was closed laparoscopically with 2 layers of sutures. A subsequent esophagogastroduodenoscopy and air leak test were performed in every case.