Comparative study of outcome and complications of surgical management of benign gastric outlet obstruction
DOI:
https://doi.org/10.18203/2349-2902.isj20202836Keywords:
Gastrojejunostomy, GOO, Finney’s pyloroplasty, Hienke-Mikulicz pyloroplastyAbstract
Background: Gastric outlet obstruction (GOO) implies complete or incomplete obstruction of the distal stomach, pylorus, or proximal duodenum. There are many causes of benign GOO like acid ingestion, pyloric stenosis, peptic ulcer etc. The main aims of this study were to compare the perioperative morbidity and short and long term complications of different procedures for benign gastric outlet obstruction.
Methods: This non-randomised retrospective study was undertaken in the department of General Surgery, SMIMER Hospital, Surat, Gujarat, India from August 2016 to July 2019. Thirty patients had been operated during this period and included in the study. Records of all 30 patients were retrieved and analysed. All these patients underwent pre-operatively upper GI scopy with biopsy and CECT abdomen.
Results: Nausea and Vomiting was most common symptoms at time of presentation in our study. Incidence of wound infection in open Gastrojejunostomy group was very high i.e. 25% and hospital stay was also very high in open Gastrojejunostomy group. Post-operative PPI dependence was more common in Gastro-jejunostomy group in all follow up and there was no any requirement of PPI in Heineke-Mikukicz and Finney’s pyloroplasty group.
Conclusions: On comparison of different surgical modalities for management of benign GOO, all surgeries performed laparoscopically were safe and carried comparatively less morbidities (perioperative, short term and long term) in comparison to open methods. Among all three laparoscopic procedures, outcome of laparoscopic pyloroplasty, both H-M pyloroplasty and Finney’s pyloroplasty were better than laparoscopic gastro-jejunostomy.
References
Samad A, Whanzada TW, Shoukat I. Gastric outlet obstruction: Change in aetiology. Pak J Surg. 2007;23:29-32.
Johnson CD. GOOmalignant until proved otherwise. Am J Gastroenterol. 1995;90:1740.
Tendler DA. Malignant gastric outlet obstruction: Bridging another divide. Am J Gastroenterol. 2002;97:4-6.
Kotisso R. GOOin Northwestern Ethiopia. East Centre Afr J Surg. 2000;5:25-9.
Appasani S, Kochhar S, Nagi B, Gupta V, Kochhar R. Benign gastric outlet obstruction- spectrum and management. Trop Gastroenterol. 2011;32:259-66.
Norman SW, Christopher JK, O’Connell PR. Bailey and Love’s Short Practice of Surgery. 25th ed. Vol. 67. Boca Raton, US: CRC Press; 2008:1045-1079.
Micheal JZ, Stanley WA. Maingot’s Abdominal Operations. 11th ed. New York: Mc Graw Hill; 2007: 365.
Broderick JT, Mathews JB. Ulcer complications. In: Zinner MJ, Ashley SW, eds. Maingot’s abdominal operations. 11th Ed. New York: McGraw Hill; 2007: 365.
Primrose JN. Stomach and duodenum. In: Williams NS, Bulstrode CJK, O’Connell PR, eds. Bailey and Love’s short practice of surgery. 25th ed. London (UK): Arnold Publisher; 2008:1045-1079.
Yeo CJ. Shackelford’s Surgery of the Alimentary Tract. 6th ed. Elsevier publication; 2007:717-732.
Godadevi TR, Reddy RA. A Clinical Study and Management of GOOin Adults. Int J Scient Study. 2016;4(6):104-8.
Tejas AP, Jade R, Srinivas S. Gastric outlet obstruction: clinical presentations and its surgical management. Int Surg J. 2018;5(2):622-5.
Fisher DR, Ebert PA, Zenidena GD. Obstructing peptic ulcers results of treatment. Arch Surg. 1967;94:724-9
Zhang LP, Tabrizian P, Nguyen S, Telem D, Divino C. Laparoscopic gastrojejunostomy for the treatment of gastric outlet obstruction. J Soc Laparoendosc Surg. 2011;15(2):169.
Moggia E, Athanasopoulos PG, Hadjittofi C, Berti S. Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges. Ann Translat Med. 2016;4(10).