A novel surgical technique: gasless laparoscopy-assisted gastrojejunostomy

Gastrojejunostomy is often performed to relieve the symptoms of gastric outlet obstruction. The recent trend is toward minimally-invasive procedures to reduce recovery time and increase quality of life. However, several problems and complications have been reported using gas-filled laparoscopy, especially in the elderly and patients with poor cardiopulmonary function. Consequently, we developed a new gasless laparoscopy-assisted gastrojejunostomy procedure to eliminate the cardiopulmonary risks of gas-filled laparoscopic surgery. The working cavity is created by lifting the mini-laparotomy incision using a self-supporting retractor that we designed, and two to three additional working ports are created. Antecolic side-to-side gastrojejunostomy is performed using an endostapler. Eleven patients (3 males and 8 females) underwent this new procedure between April 2005 and May 2006. Their median age was 75 years (range 34 to 85), and eight of the eleven had more than three comorbid conditions. The median duration of postoperative flatus was 2 days (1-10 days), and the median hospital stay 10 days (5-28 days). No postoperative leakage occurred. However, one patient with postoperative gastrostasis and another with ileus due to cancer-related peritonitis were noted; fortunately, both responded to conservative medical management. In conclusion, our gasless, laparoscopy-assisted gastrojejunostomy procedure appears to be both safe and effective in patients with gastric outlet obstruction.