A gastrojejunostomy is a surgical procedure that directly connects the stomach to the jejunum, the second section of the small intestine, by a small tube. The tube allows food, liquids, and medications to bypass the duodenum, the first section of the small intestine. People who have stomach or duodenum blockages, often caused by stomach or pancreas cancer, and cannot properly digest food may need to have this procedure done. In one common version of this procedure, one end of the tube is left in the patient's intestines, with the other end outside of the abdomen, to be used for feeding and giving nutrients for as long as necessary; this is often referred to as a GJ tube or feeding tube.
How the Surgery Is Performed
During the surgery, the patient may be offered sedatives to help reduce the pain, a local anesthetic to numb the incision area, or in some cases be put to sleep with general anesthesia. Some other preparatory steps include setting up and using an ultrasound machine to enable the health care specialist to view exactly where to insert and move the tube. The stomach is filled with air and stapled to the abdomen so the tube can be placed properly; the staples are usually removed the next day. The skin around the incision area is also cleansed to kill any bacteria.
At this point, the patient should be ready for the surgeon to create an opening in the abdomen. There are two basic methods of making the incision: the original gastrojejunostomy procedure, which uses an open cut in the abdomen, and a percutaneous gastrojejunostomy, which uses a small, needle-like puncture in the abdomen. Both methods access the stomach and jejunum through the patient's abdomen, but the second method generally creates a much smaller incision than the first; this usually results in less bleeding, fewer complications, and a faster recovery. Once the incision has been made, the tube is inserted into the stomach, usually just below the rib cage.
Recovery
The entire procedure usually takes about one hour and is relatively painless; however, pain medication may be given if there is discomfort. Once the tube is in place and the incision is closed, the patient will spend about 24 hours in the hospital to be monitored and to learn how to properly use and care for the feeding tube. The GJ tube and surgical incision must be kept clean and sterile to avoid infection. In many cases, a caregiver will also learn how to use and care for the feeding tube in case the patient is unable to do it alone.
How To Prepare
Before undergoing this type of surgery, the patient should be sure to inform his or her doctor of any medications that are being used. It may be necessary to stop taking or reduce the medications ahead of time as some may cause complications. The health care staff should also be told about any allergic reactions to medications or anesthetics and any other health conditions the patient has experienced in the past. Gastrojejunostomy patients should fast before surgery, generally for a minimum of six hours; the length of the fast and whether or not the fast includes abstaining from both food and liquids should be verified with the health care provider.
Risks
As with most surgeries, there is a risk that side effects can occur after the operation. Infection can occur around the incision in the abdomen, as well as internally. Occasionally, bleeding will occur internally or at the incision, resulting in an excessive loss of blood. During a percutaneous gastrojejunostomy, it is possible for an organ to be punctured when the incision is made. Other risks include leaking between the stomach and small intestines, problems with intestines slowing down or not working, and side effects from anesthesia or other medication.
