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Gastric outlet obstruction in carcinoma gall bladder
A Chaudhary1, P Dhar, A Sachdev
1Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital, New Delhi. adarsh@nda.vsnl.net.in
Summary
Gastric outlet obstruction frequently complicates advanced gallbladder cancer. Gastrojejunostomy offers effective palliation for these patients, with most experiencing relief from symptoms like vomiting.
Area of Science:
- Oncology
- Surgical Gastroenterology
- Hepatobiliary Surgery
Background:
- Gastric outlet obstruction (GOO) is a known complication of advanced gallbladder malignancy.
- Palliative surgery, such as gastroenterostomy, is often required for symptomatic or incipient GOO in these cases.
Purpose of the Study:
- To review the outcomes of gastrojejunostomy in patients with gallbladder cancer and gastric outlet obstruction.
- To assess the efficacy of gastrojejunostomy as a palliative procedure for advanced gallbladder neoplasms.
Main Methods:
- Retrospective review of 39 patients (24 women, 15 men) over nine years.
- Patients underwent gastrojejunostomy for symptomatic or impending gastric outlet obstruction due to locally advanced gallbladder cancer.
- Surgical procedures included anterior gastrojejunostomy, with 15 patients also receiving a billoenteric bypass.
Main Results:
- Twenty-two patients had symptomatic GOO, and 17 had impending obstruction.
- Duodenal obstruction, primarily by direct tumoral infiltration (64%), was common.
- Two postoperative deaths occurred; 8 patients experienced delayed gastric emptying, managed conservatively. Thirty patients remained free of vomiting post-procedure.
Conclusions:
- Gastric outlet obstruction is a frequent complication of gallbladder cancer.
- Gastrojejunostomy provides satisfactory palliation for most patients with gastric outlet obstruction secondary to gallbladder cancer.