Laparoscopic exclusion gastroenterostomy for palliation of gastric outlet obstruction secondary to recurrent cholangiocarcinoma.

The Devine exclusion gastroenterostomy is recommended as a palliative procedure for unresectable gastric carcinoma, and avoids the problem of delayed gastric emptying. It is conventionally performed by a laparotomy. We report the successful laparoscopic application of this technique in a patient with gastric outlet obstruction secondary to recurrence of a previously resected hilar cholangiocarcinoma. A 38-year-old gentleman who had undergone a left hepatectomy with caudate lobectomy, excision of extrahepatic biliary tree, D2 regional lymphadenectomy and Roux-en-Y right hepaticojejunostomy presented 6 months later with symptoms of gastric outlet obstruction. Computed tomography revealed a tumor mass in the region of the gastric antrum. Attempted endoscopic treatment with a metal stent was unsuccessful. He underwent a laparoscopic exclusion gastroenterostomy. The operative time was 200 minutes. Postoperative recovery was uncomplicated. There was no delay in gastric emptying and no recurrence of gastric outlet obstruction until the time of death 41 days later. Laparoscopic exclusion gastrojejunostomy is a feasible option for the palliation of gastric outlet obstruction caused by recurrent cholangiocarcinoma.