Comparative study of outcome and complications of surgical management of benign gastric outlet obstruction

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.

Superior mesenteric artery syndrome: a single centre experience of laparoscopic duodenojejunostomy as the operation of choice

INTRODUCTION The superior mesenteric artery (SMA) syndrome, or Wilkie’s syndrome, is a rare cause of postprandial epigastric pain, vomiting and weight loss caused by compression of the third part of the duodenum as it passes beneath the proximal superior mesenteric artery. The syndrome may be precipitated by sudden weight loss secondary to other pathologies, such as trauma, malignancy or eating disorders. Diagnosis is confirmed by angiography, which reveals a reduced aorto-SMA angle and distance, and contrast studies showing duodenal obstruction. Conservative management aims to increase intra-abdominal fat by dietary manipulation and thereby increase the angle between the SMA and aorta. Where surgery is indicated, division of the ligament of Treitz, anterior transposition of the third part of the duodenum and duodenojejunostomy have been described. METHODS We present four cases of SMA syndrome where the intention of treatment was laparoscopic duodenojejunostomy. The procedure was completed successfully in three patients, who recovered quickly with no short-term complications. A fourth patient underwent open gastrojejunostomy (complicated by an anastomotic bleed) when dense adhesions prevented duodenojejunostomy. CONCLUSIONS The superior mesenteric artery syndrome should be considered in patients with epigastric pain, prolonged vomiting and weight loss. Laparoscopic duodenojejunostomy is a safe and effective operation for management of the syndrome. A multi-speciality team approach including gastrointestinal, vascular and radiological specialists should be invoked in the management of these patients.