GASTRO-JEJUNOSTOMY & VAGOTOMY

Gastrojejunostomy with truncal vagotomy is the chosen procedure for Gastric Outlet Obstruction  due to Peptic Ulcer Disease. It implicates an anastomosis (a short cut) between the stomach and the beginning of the small intestine (gastro-jejunostomy) and cutting of the nerve which is controlling the acid production of the stomach, the Vagus nerve (vagotomy).

I prefer a posterior retrocolic anastomosis (behind the large intestine) in one layer with a continuous suture line.

 g-j-1

 g-j-2

Dilated stomach with scarring

Opening cut in the mesocolon

 g-j-3

 g-j-4

Backside of the stomach drawn through the ….

..opening in the mesocolon

 g-j-5

 g-j-6

First part of the small intestine at Treitz’s ligament                       

A short loop of the small intestine mobilized…..

 g-j-7

 g-j-8

.. and approached to the stomach wall

Small intestine cut open

 g-j-9

 g-j-10

Stomach and intestine cut open

Posterior suture line in progress

 g-j-11

 g-j-12

Posterior suture line completed

Anterior suture line completed

 g-j-13

 g-j-14

Closing the defect in the mesocolon

Defect in mesocolon closed

 

The Vagotomy is total and truncal

 vagotomy-1

 vagotomy-2

Esophagus isolated by digital dissection

The thick right Vagus nerve is isolated

 vagotomy-3

 vagotomy-5

The right Vagus nerve is cut

The thin left Vagus nerve being cut