Laparoscopic Gastrojejunostomy

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Essential equipment:

  • Two 5mm (R hypochondrium mid clavicular line & L lat border rectus level umbilicus) 
  • Two 12mm umbilical trocars (umbilicus & lateral margin Right rectus below umbilicus) 
  • Two 5mm fenestrated Johan grasping forceps 
  • Two 5mm needle holders
  • ATG45 (green) with reload

Identify the ligament of Treitz and run the bowel to a point at least 50cm away.  Check that he loop easily reaches the stomach without tension.

Choose a sight low on the greater curve of the stomach.  Air distension (via NGT) may help.  Go for an anticolic loop.

Place two stay sutures to approximate the stomach and jejunum and then carefully pull out of the two 5mm lateral trocars.

Using scissors, make two enterotomies (8mm long), pass and fire your stapling device of choice.  Make sure that they are intraluminal.

Inspect the staple line for bleeding.  Consider irrigating the staple line.  Use cautery with caution to avoid a thermal burn.

Close the enterotomies with a running suture or change the R lateral 5mm for 12mm and use a stapling device.  Take care not to narrow the jejunal lumen.  Revise it if you are not happy.

Inflate the stomach and check for leaks (under a pool of saline). 

Place a suction drain besides the anastomosis.

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SPIRE Hospital, Bristol. 
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