General Surgery Department, Shamir medical center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Gastroenterology, Rabin medical center, Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Laparoendosc Adv Surg Tech A. 2024 Aug;34(8):727-730. doi: 10.1089/lap.2024.0162. Epub 2024 Jul 8.
Gastric outlet obstruction (GOO) is a common complication in advanced stage upper gastrointestinal malignancies. The symptoms of severe nausea and protracted vomiting can lead to a decline in quality of life and cachexia. Symptoms of GOO can be effectively managed with either operative or nonoperative palliative interventions. In our article, we aim to compare laparoscopic gastrojejunostomy (GJ) to endoscopic stenting as palliative interventions for GOO. We retrospectively evaluated the charts of patients who underwent palliative procedure for gastric outlet obstruction. Group I included patients who underwent endoscopic stenting, and group II patients underwent Laparoscopic GJ. The groups' demographics (age, gender), length of procedure, length of stay, days to oral intake, overall survival, complications rate, and 30-day mortality rates were compared. Overall, 38 patients were included in the study. Nineteen patients underwent endoscopic stenting and 19 underwent laparoscopic GJ. Comparing the groups, no significant differences were noted. Surgical time was significantly longer than the endoscopic procedures (83 minutes versus 25 minutes, = .001). No significant differences were noted in days of oral intake initiation, overall survival and 30-day mortality rates. Five patients in the stenting group had complications (26.3%) versus none in the surgical group ( = .046). No postoperative complications were noted. Laparoscopic GJ is a safe and feasible treatment for GOO, demonstrating early resumption of oral intake. The relative short hospital stay, combined with an encouraging postoperative complications profile and low reintervention rate, should be kept in mind especially among patients with longer life expectancy.
胃出口梗阻（GOO）是晚期上消化道恶性肿瘤的常见并发症。严重的恶心和长期呕吐的症状可导致生活质量下降和恶病质。严重的 GOO 症状可以通过手术或非手术姑息性干预来有效治疗。在我们的文章中，我们旨在比较腹腔镜胃空肠吻合术（GJ）和内镜支架置入作为 GOO 的姑息性干预措施。我们回顾性评估了接受姑息性手术治疗胃出口梗阻的患者的病历。组 1 包括接受内镜支架置入的患者，组 2 患者接受腹腔镜 GJ。比较两组的人口统计学特征（年龄、性别）、手术时间、住院时间、开始口服摄入的天数、总生存期、并发症发生率和 30 天死亡率。共有 38 例患者纳入研究。19 例患者接受内镜支架置入，19 例患者接受腹腔镜 GJ。两组比较，无显著差异。手术时间明显长于内镜手术（83 分钟与 25 分钟， =.001）。开始口服摄入的天数、总生存期和 30 天死亡率无显著差异。支架组有 5 例（26.3%）患者发生并发症，而手术组无患者发生并发症（ =.046）。无术后并发症发生。腹腔镜 GJ 是治疗 GOO 的一种安全可行的方法，可早期恢复口服摄入。相对较短的住院时间，加上令人鼓舞的术后并发症谱和较低的再干预率，应特别注意预期寿命较长的患者。
