Laparoscopic gastroenterostomy for duodenal obstruction

Background It is not yet clear where laparoscopic procedures will fit into the armamentarium of the surgeon. Over the past decade, there has been a clear trend toward minimally invasive procedures for palliation of inoperable cancer. Traditionally, when duodenal obstruction occurs secondary to a disease process, gastric bypass through laparotomy is required. Patients and methods Between November 13, 1992 and September 13, 1994, 10 patients underwent laparoscopic gastroenterostomy for duodenal obstruction. In 9 patients, the procedure was carried out for malignant obstruction; in 1 patient, duodenal obstruction was secondary to chronic scarring from benign peptic ulcer disease. Eight of these patients already had biliary decompression through radiologic or endoscopic means. One patient underwent laparoscopic cholecystenterostomy for biliary obstruction in addition to the laparoscopic gastroenterostomy. Results Laparoscopic gastroenterostomy was successfully completed in 8 of the 10 patients. In 2, conversion to open surgery was necessary. There was no mortality related to this operative approach. Conclusions Laparoscopic gastroenterostomy is a safe procedure for treatment of duodenal obstruction. Good palliation can be expected in patients with obstruction of the duodenum secondary to advanced malignancies.