Gastrojejunostomy

What is a gastrojejunostomy?

A gastrojejunostomy is a surgical procedure that creates a new connection (anastomosis) between your stomach and the middle section of your small intestine, called the jejunum. The new connection reroutes the passage of food from your stomach into your small intestine, bypassing the first section of your small intestine, called the duodenum.

Sometimes the term, “gastrojejunostomy,” is used to describe a minor procedure to place a feeding tube in your small intestine. The tube is called a gastrojejunostomy tube because it passes through your stomach and duodenum into your jejunum (mid-intestine). This is a different procedure, however — called a percutaneous gastrojejunostomy.

Why is gastrojejunostomy surgery done?

You might need your food to bypass your duodenum if your duodenum has a medical problem or isn’t working correctly — for example, if it’s blocked. The problem could also be in your lower stomach (antrum). If the outlet at the bottom (pylorus) isn’t allowing food to pass through, sometimes the solution is to attach your small intestine to the upper part of your stomach.

Gastrojejunostomy can also be part of a weight loss surgery procedure. The Roux-en-Y gastric bypass is one type of gastrojejunostomy. This procedure bypasses part of your stomach along with your duodenum. The purpose of the bypass in this case is to reduce the amount of food your stomach can hold and the amount of nutrients your small intestine can absorb.

What conditions are treated with gastrojejunostomy?

You might have a gastrojejunostomy to treat:

• Gastric outlet obstruction (GOO): When the outlet at the bottom of your stomach is blocked.
• Duodenal obstruction: When the obstruction is in your duodenum.
• Stomach cancer or duodenal cancer: When cancer causes an obstruction or requires the removal (resection) of part of your stomach or duodenum.
• Peptic ulcer disease: When complications, such as bleeding or scarring, interfere with food passing through your stomach or duodenum.

Less commonly, you might have a preventative gastrojejunostomy to avoid complications if you have:

• Severe injury (trauma) to your duodenum. If your surgeon believes that your injured duodenum is at high risk of developing a fistula, they may judge that it’s safer to divert food away from the injury while it heals. Your duodenum could develop a fistula, an abnormal tunnel or passageway, to your pancreas if persistent inflammation erodes the wall between them.
• Pancreatic cancer that can’t be removed. If you have cancer in your pancreas where it meets your duodenum and it can’t be removed, it could grow to obstruct the outlet between your stomach and duodenum. Your surgeon might judge that it’s safer to redirect your gastrointestinal tract before this happens.

What happens before a gastrojejunostomy?

Depending on the condition you’re being treated for, you may need other treatments before you’re ready for surgery. For example, if your gastrointestinal tract has been blocked, you’ve probably had some trouble keeping food down. You may have been vomiting a lot and may be dehydrated and/or malnourished.

Your healthcare team will want you to be in the best health possible before surgery. They may treat you first with:

• IV fluids. Fluids can be customized to correct any electrolyte imbalances you might have.
• IV nutrition. You can receive supplemental nutrition or total nutrition through an IV.
• Blood transfusion. You may need extra blood if you have anemia.
• Antibiotics. Prophylactic antibiotics before surgery to help prevent infections.
• Gastric decompression. This treatment involves placing a nasogastric tube down your throat and into your stomach. The tube removes some of the stomach contents, which relieves pressure and makes it safer to put you to sleep with anesthesia.

What happens during a gastrojejunostomy?

There are different variations to the procedure, but in general, your surgeon will:

• Put you to sleep under general anesthesia.
• Place a nasogastric or orogastric tube into your stomach to decompress it.
• Access your abdominal cavity using either an open or laparoscopic technique.
• Locate the problem in your stomach or duodenum that needs to be removed or excluded.
• Measure out a loop of jejunum at least 10 centimeters (cm) from the end of the duodenum.
• Attach the loop of jejunum to your stomach at least 5 centimeters above the problem site.
• Check the new connection (anastomosis) for leaks using one of several techniques.
• Close the incision(s) and complete the surgery.

How long is the gastrojejunostomy procedure?

It usually takes between two and four hours.

What happens after a gastrojejunostomy?

You’ll be admitted to the hospital after surgery. It can take some time before you’re ready to tolerate solid food. You might have some nausea, or your bowels might be slow to move after surgery (paralytic ileus). In some cases it takes a long time for the stomach to empty through the new connection. Some people need to keep a nasogastric tube in for several days.

You might stay on IV fluids and nutrition at first, or you might begin with a clear liquid diet and gradually transition to a soft diet before going home. Occasionally, it can take several weeks for your stomach to start working again after surgery. In this case, you may continue to be fed through a tube or an IV.

What are the possible risks or complications of this procedure?

Certain risks come with any surgical procedure, including:

• Bleeding.
• Blood clots.
• Damage to nearby organs.
• Excessive internal scar tissue.

Additional risks with gastrojejunostomy include:

• Anastomotic leak. This is a rare but recognized complication in which the new anastomosis between your stomach and intestines leaks. It can cause infection in your abdominal cavity. If the infection spreads to your bloodstream, it could trigger a life-threatening reaction (sepsis).

What are the possible long-term side effects of this procedure?

• Dumping syndrome. Dumping syndrome is a common but usually temporary side effect of gastric/intestinal bypass surgery. It’s a collection of symptoms that occur after eating, when food from your stomach passes into your small intestine at the new connection point. This passage of food may be less gradual and controlled than it used to be, and your digestive system may react at first with symptoms such as nausea, bloating and indigestion. It adjusts over time.
• Marginal ulcer. Usually, peptic ulcers only develop in your stomach or duodenum, where stomach acids reside. Your duodenum is equipped to neutralize the leftover stomach acids that pass to it from your stomach. But when your duodenum is bypassed, these acids pass directly into your jejunum, which isn’t equipped to handle them. This can cause ulcers in your jejunum.
• Bile reflux. One of the jobs of the pylorus, the valve that separates your stomach from your duodenum, is to keep digestive juices in your duodenum from entering your stomach. These juices, which include bile, can irritate your stomach lining. When you bypass the pylorus and/or duodenum, you run the risk that the new connection between your stomach and small intestine won’t be as effective at keeping bile out. This can cause bile reflux.

What is the recovery after gastrojejunostomy like?

It takes an average of six weeks to recover. It may take more or less time, depending on how extensive your operation was and whether you had open or laparoscopic surgery. You may have had part of your stomach and part of your small intestine divided or removed. If you had cancer, you might have had additional tissue removed, as well.

Your healthcare team will instruct you on how to care for your incision wound(s), how to manage your pain at home and when you can resume your regular activities. They’ll schedule a follow-up appointment with your healthcare provider a few weeks after you go home. At the appointment, they’ll check you for any signs of complications in your recovery.

You may have to follow a special diet for several months after your operation. The specifics will depend on how much of your stomach and/or intestine was removed and whether you’re experiencing symptoms of dumping syndrome. You may have to watch your nutrition more carefully than before, take vitamin supplements and avoid foods high in sugar.

When should I call my healthcare provider about my recovery?

Contact your healthcare team if:

• You notice any signs of wound infection, such as redness, pain, warmth or swelling.
• You have a fever above 100 degrees Fahrenheit/ 38 degrees Celsius.
• You’re having trouble managing your pain.
• You’re having trouble eating or keeping food down.
• You have persistent diarrhea.
• Your skin or the whites of your eyes turn yellow.

Is gastrojejunostomy a major surgery?

There’s no standard definition of “major” vs. “minor” surgery, so the answer depends on your perspective. On the one hand, any surgery that alters your gastrointestinal tract is a big deal. It’s relatively complicated and takes several hours. It changes the natural course of your digestive system, and you might experience side effects afterward.

On the other hand, the procedure can often be done using minimally-invasive techniques. That means you don’t necessarily have to have open abdominal surgery, which involves a long incision through your abdomen and a longer healing time. Depending on your condition and your surgeon, you may be able to have laparoscopic surgery instead.

Laparoscopic surgery is a less invasive alternative to open surgery. It’s all done through smaller, half-inch “keyhole” incisions in your abdomen. A tiny camera called a laparoscope goes into one of the keyholes and projects images onto a screen while the surgeon operates through other keyholes. These incisions heal relatively quickly and with less pain.

A note from Cleveland Clinic

A gastrojejunostomy alters your digestive system significantly (and usually permanently). While this may be beneficial or even necessary for your condition, it’s nevertheless a big transition. Ask for all the help you need as you prepare for the procedure and for your diet and lifestyle adjustments afterward. Your healthcare team is there to advise you at every step.