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

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