Gastrojejunostomy with Duodenal Partition for Unresectable Periampullary Cancer

Shin, Jun Ho; Park, Jae Jun; Han, Won Kon

Abstract

PURPOSE: The most appropriate palliative treatment to relieve symptoms caused by extrahepatic biliary obstruction appears to be a surgically constructed double bypass. However, gastrojenunostomy may be a disease rather than an operation because the ingested food would take the duodenal route and reenter the stomach through the gastrojejunostomy. Therefore, there has been a renewed interest in the role of the duodenal partition for preventing this circulus vomitig.
METHODS
A total of 97 patients were treated with palliative loop gastrojejunostomy due to unresectable periampullary cancer at Kangbuk Samsung Hospital between March 1998 and December 2000. Of the 56 patients of this group who underwent prophylactic gastrojejunostomy, 25 patients had both gastojejunostomy and duodenal partition (Group I) and 31 gastrojejunostomy alone (Group II).
RESULTS
The postoperative in-hospital mortality rate was 0 percent and the morbidity rate was 5.4 percent. However, the morbidity rate associated with duodenal partition was 0 percent. Circulus vomiting was absent in patients who had a duodenal partition, although statistical analysis did not show this to be significant. The reason for the statistical insignificance of the result may be the relatively small sample size.
CONCLUSION
Due to the ease and safety of the technique, the duodenal partition added to the loop gastrojejunostomy decreased circulus vomiting without prolonging the operative time or increasing the compication rates. This finding suggests that the duodenal partition should be liberally applied in prophylactic gastric bypass procedures.