LAPAROSCOPIC GASTROJEJUNOSTOMY AND ENDOSCOPIC BILIARY STENT PLACEMENTFOR PALLIATION OF INCURABLE GASTRIC OUTLET OBSTRUCTION WITH CHOLESTASIS

Background: For patients with incurable malignant gastric outlet obstr uction and cholestasis, laparoscopic gastrojejunostomy combined with e ndoscopic biliary stent placement seems to offer a minimally invasive palliation. Methods: We retrospectively analyzed the data of 16 patien ts submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroent erostomy was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved preop eratively by stent placement via endoscopy (n = 6, 37.5%), percutaneou s access (n = 5, 31%) or bilioenteric anastomosis (n = 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively. Res ults: Mean operative time was 126 min. There were no intraoperative co mplications. In one patient conversion to open surgery became necessar y because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention; there was no mortality. Median postoperative hospital stay was 7 days. Delayed gas tric emptying was observed in 3 (18.7%) patients. Median survival was 87 days after the operation. All patients died from their primary dise ase but could maintain oral intake during the remaining survival time. Conclusions: We conclude that laparoscopic gastrojejunostomy and endo scopic or percutaneous biliary stenting provide a good functional resu lt while impairing the quality of life only to a minimal extent.