Gastrojejunostomy (Antecolic / Retrocolic)

Procedure Snapshot

• Indication: Gastric outlet obstruction, palliative bypass, Billroth II reconstruction.
• Expected duration: ___
• Special instruments: Linear stapler, energy device, stay sutures.

Step Workflow

1. Identify proximal jejunum (~30 cm from Treitz).
2. Choose antecolic or retrocolic loop.
3. Create gastrotomy on greater curvature of stomach.
4. Create matching enterotomy; fire stapler to form side-to-side anastomosis.
5. Close common enterotomy in two layers.
6. Leak test; ensure no torsion or kink.

Key Pimp Questions

• Q: Why Roux vs loop GJ?
  A: Roux reduces bile reflux (PMID 32701694).
• Q: Typical site?
  A: Stomach body → proximal jejunum ~30 cm distal to Treitz.

Critical Anatomy

• Landmarks: Greater curvature, jejunum, mesocolon.
• Danger zones: Pancreas, transverse colon, mesocolic window.

Informed Consent Highlights

• Risks: Leak __ (PMID 35635268), bleeding __, obstruction ___.

Post-op Considerations

• NGT until return of bowel function; slow diet advance.

References

• Chassin’s, Gastric section.
• Clinical Scenarios, Upper GI.
• Tokunaga 2020 (PMID 32701694).