Editing Gastrojejunostomy


== Choices: ==

* Antecolic or retrocolic
* Posterior or anterior on     stomach (some say posterior has better drainage in dependent position)
* Sewn vs stapled
* Suture - usually 3/0 PDS for     everything
* Single-layer or double-layer

== Hand-sewn side-to-side in two layers ==

* Bring up loop of jejunum at     point of least tension
* PDS stay sutures proximal and     distal, 4cm apart
* '''Posterior     outer layer:'''
** Continuous Lembert suture
** Leave both ends long with      needle left on and protected
* '''Gastrotomy:''' longitudinal incision on     greater curvature, anterior to gastrocolic ligament, approx. 4cm long
* '''Jejunostomy:''' 4cm incision in     antimesenteric aspect of jejunum
* '''Posterior/anterior     inner layer:'''
** Start at bottom right corner      - out to in, then in to out, then tie with long tail
** Back in to lumen and then      continuous full-thickness suture along back wall
** Careful apical suture at      other corner and then return along anterior wall with a Connell suture to      invert it (seromuscular bites only)
** Tie back onto long tail
* '''Anterior     outer layer:''' 
** Continuous seromuscular      bites
** Tie back to starting suture
* Tie stay sutures
* Check patency with finger     pinch and can try underwater seal with NGT
* Place NGT beyond joint and     palpate
* Leave drain

[[Category:UGIS operations]]