Our digestive system works wonders to properly digest and absorb the food we eat. But imagine, what happens if there is an obstacle somewhere along this journey, like a blocked road? Food cannot move forward. In such cases, a special surgery is called a Gastrojejunostomy, which is used to bypass that obstacle and create a new path for food to pass through. A doctor may have told you about this, or you may have heard about it and become curious. Let's talk about this very simply, in a way that you can understand.
Simply put, what is Gastrojejunostomy surgery?
A gastrojejunostomy is a surgical procedure that creates a new connection between your stomach and the middle part of your small intestine, called the jejunum. In other words, it allows food to pass from the stomach directly into the middle part of the small intestine, called the duodenum, instead of going into the duodenum. This new connection is called an anastomosis in medical terms.
Imagine digging a big hole in a road and making it impossible for vehicles to pass through. Then we cut a new road on the other side of the hole and send the vehicles through, right? That's what this surgery does.
But there's one thing to remember. There's another thing that's sometimes called the same thing. That's a feeding tube, a tube that's inserted into the small intestine to feed someone who has difficulty eating. It also goes through the stomach and into the jejunum, so it's called a gastrojejunostomy tube. But that's not the major surgery we're talking about. That's a separate procedure.
Why do we need this kind of surgery?
The main reason for this surgery is that there is an obstruction in the passage of food from the stomach or in the first part of the small intestine. This obstruction prevents food from moving forward. There are several such conditions.
| Condition | A Simple Explanation |
|---|---|
| Gastric Outlet Obstruction (GOO) | The pylorus, the opening at the bottom of the stomach where food enters the small intestine, becomes blocked for some reason. |
| Duodenal Obstruction | The obstruction is not in the stomach, but in the first part of the small intestine that follows it (duodenum). |
| Stomach or Duodenal Cancer | Blockage of the esophagus due to a cancerous tumor or as part of surgery to remove the tumor. |
| Peptic Ulcer Disease | Complications such as bleeding from wounds that do not heal, or scarring of the wounds that can block the digestive tract. |
In addition, sometimes this surgery is also performed to prevent a possible problem in the future .
- Trauma to the small intestine: If the first part of the small intestine is severely damaged, such as in an accident, this bypass is done to stop food from passing through it until it heals. Otherwise, an abnormal hole (fistula) can form through the injury, damaging nearby organs such as the pancreas.
- Pancreatic Cancer: If pancreatic cancer is located near the small intestine and cannot be removed surgically, it may grow and block the food pipe in the future. Before that happens, doctors may decide to perform this surgery as a precaution.
What happens before the surgery? How is the preparation?
The medical team will try to get you as healthy as possible before the surgery. Imagine, someone with a blocked esophagus can't eat and is constantly vomiting. This can lead to dehydration and malnutrition . So these things need to be corrected before the surgery.
Your medical team may do things like:
- Saline (IV fluids): Saline is given into a vein to correct fluid retention and electrolyte imbalances.
- IV nutrition: Since you cannot eat by mouth, the necessary nutrition is given directly into a vein.
- Blood transfusion: If you have anemia, you may need to have a blood transfusion.
- Antibiotics: Antibiotics are given beforehand to prevent infection after surgery.
- Gastric decompression:A tube is inserted through the nose into the stomach, and some of the contents are removed to reduce the pressure. This increases safety when administering anesthesia.
What happens during the surgery?
Although there are various ways to perform this surgery, these are the steps that usually occur.
1. Anesthesia: First, you are put completely asleep (general anesthesia). You will not feel anything.
2. Gastric emptying: A tube is inserted through the nose or mouth to remove the contents of the stomach and reduce the pressure.
3. Entering the abdominal cavity: The surgeon enters the abdominal cavity. This can be done in two ways. One is open surgery , which involves making a small incision in the abdomen. The other is laparoscopic surgery, which involves making a few small incisions in the abdomen and inserting a camera and thin instruments. This is also called "keyhole surgery."
4. Identifying the location of the problem: The exact location of the obstruction in the stomach or small intestine is found.
5. Preparing the small intestine: A loop is made from the middle part (jejunum) about 10 centimeters from the end of the first part of the small intestine (duodenum).
6. Creating a new connection: The created small intestine section is connected to the stomach at least 5 centimeters above the obstruction. This is the new 'bypass' route we mentioned earlier.
7. Inspection: The newly created anastomosis is checked using various methods to ensure that it is properly connected and that there is no leakage.
8. Completion of the surgery: If everything is OK, the incisions/holes made will be closed and the surgery will be completed.
Typically, this surgery can take about two to four hours .
What happens after the surgery?
After the surgery, you will be hospitalized. You may not be able to eat normally right away. You may feel a little nauseous for the first few days. Sometimes, after surgery, your intestines become a little "lazy" (paralytic ileus). This means that their function slows down a bit.
Initially, you may be given saline and nutrition through a vein. Then, you may start with a clear liquid diet , gradually moving to a soft diet, and then gradually introduce regular foods before you go home. It may take a few weeks for some people to adjust to the new connection in their stomach. During this time, you may need to continue to be fed through a tube or intravenously.
What are the possible risks and complications of this surgery?
As with any surgery, there are some risks involved. Not everyone will experience these, but it's good to be aware of them.
| Risk type | Description |
|---|---|
| Risks common to any surgery |
|
| Risks specific to this surgery | Anastomotic leak: This is a rare condition. The newly created connection does not seal properly, and stomach or intestinal contents leak into the abdominal cavity. This can cause serious infections. If the infection gets into the blood, it can be life-threatening (sepsis). |
Side effects that may occur after surgery
Even if the surgery is successful, some side effects may occur over time. Most of these can be controlled.
| Side Effect | What happens to it? |
|---|---|
| Dumping Syndrome | Food suddenly and rapidly "dumps" from the stomach into the small intestine. This causes symptoms such as nausea, bloating, stomach cramps, and sweating after eating. This usually subsides after a while as the body adjusts to it. |
| Marginal Ulcer | Normally, stomach acids are in the stomach and the first part of the small intestine. Those parts are built to withstand them. But because of this bypass, stomach acids go directly into the middle part of the small intestine (jejunum). That part cannot withstand the acids. Therefore, ulcers can form there. |
| Bile Reflux | Normally, substances that help with digestion, such as bile, are prevented from flowing back into the stomach. But because of this new connection, it is possible for those substances to flow back into the stomach. This can cause inflammation of the stomach walls. |
How is the recovery time?
It usually takes about six weeks to fully recover, but this can vary depending on the type of surgery you had (open or laparoscopic) and your physical condition.
Your medical team will give you instructions on how to care for your incisions, manage pain, and when you can resume normal activities after you go home. They will also give you a date to see you again a few weeks after your surgery.
You may need to follow a special diet for a few months after surgery, especially avoiding foods high in sugar and taking vitamin supplements.
If you have these symptoms, call your doctor immediately.
If you develop any of the following symptoms after returning home, immediately notify your doctor or the hospital where you received treatment .
- If you feel redness, pain, swelling, or warmth around the incision (these are signs of infection).
- If you have a fever over 100° Fahrenheit (38° Celsius).
- If the pain is difficult to control.
- If you have difficulty eating or keeping food down.
- If you have persistent diarrhea .
- If your skin or the whites of your eyes turn yellow .
Take-Home Message
- Gastrojejunostomy is a surgery that creates a new 'bypass' path from the stomach to the esophagus.
- This is mainly done as a treatment for conditions such as obstructions in the digestive tract, cancer, or severe stomach ulcers.
- Before surgery, you will be given the necessary treatment to get you in the best physical condition.
- It takes time to recover, especially getting used to changes in diet.
- Some side effects may occur after surgery, but most of them can be managed.
- Follow your doctor's instructions exactly. If you experience any risk symptoms, seek medical advice immediately.
- This is a big change in your life, so don't hesitate to get all the help and advice you need from your medical team during this journey.
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