Carl Westcott, MD. Wake Forest Medical Center , Winston-Salem, NC.
Illustrations by Rob Flewell.CMI
Gastrojejunostomy by laparoscopic technique is described by several sources. When combined with laparoscopic exploration and biliary bypass metastatic peripancreatic cancer is often staged and palliated with out an abdominal incision.This approach obviates an abdominal incision and carries the accepted benefits of minimally invasive surgery. The safety and effectiveness are maintained by adhering to the technical principals of the open procedure.
A. Peripancreatic Malignancy
B. Benign gastric outflow obstruction
C. Gastric Dysfunction (diabetes, alkaline reflux)
The patient is placed in the supine position with arm extended.
The surgeon and assistant can stand on the same or opposite sides of the table.
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1. Preservation of efferent outflow is best accomplished by performing a hand suture of the enterotomy sites.
Holzman MD, Reintgen KL, Tyler DS et al. The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies. J Gastint Surg 1997;1:236-44.
Lillemoe KD, Sauter PK, Pitt HA et al. Current palliation of periampuilary carcinoma. Surg Gynecol Obstet 1993;176:1-10.
Collins BH, Pappas TN. Laparoscopic gastrojejunostomy. In Pappas TN, Schwartz LB, Eubanks WS, ed. Atlas of Laparoscopic Surgery. Philadelphia: Churchill Livingstone, 1996, pp 5.2-5.13.