A new technique of gastroenterostomy for palliative treatment of pancreatic head carcinoma

Background/Aims: Most of the patients with pancreatic cancer can be only pa lliatively treated. Although 30% of the patients submitted to palliative bi liary bypass will require further treatment for duodenal obstruction, proph ylactic gastric bypass still remains a controversial issue in the managemen t of unresectable pancreatic head carcinoma. The main disadvantage of curre nt techniques of gastrojejunostomy is postoperative vomiting due to impaire d gastric motility and circulus vitiosus through the nonobstructed duodenum . A new technique of prophylactic gastrojejunostomy is described herein as an attempt to obviate these complications. Methodology: An antecolic isoperistaltic gastrojejunostomy was fashioned at the gastric mid-body above the angulus. The afferent limb was partitioned close to the gastrojejunostomy and a Braun type entero-enterostomy construc ted joining the afferent and the efferent limbs. Following the gastrojejuno stomy a Roux-en-Y choledochojejunostomy was performed. Results: In 19 patients consecutively submitted to this procedure no postop erative mortality or complications occurred. Nasogastric suction was interr upted at postoperative day 3 and oral feeding resumed on the next day. Neit her early nor late postoperative vomiting was observed. Conclusions: These encouraging preliminary results suggest that this proced ure may have its place in the palliative treatment of pancreatic head carci noma.