Definition and Overview
A gastroduodenostomy is a surgical procedure that involves the creation of a new connection between the stomach and the duodenum, the first section of the human small intestine. This section is the smallest, but it is where chemical digestion—a step vital to the digestive and metabolic process—occurs.
This procedure is often recommended for patients suffering from stomach cancer, peptic ulcers, gastric obstruction, and a malfunctioning pyloric valve. There are two types of gastroduodenostomy:
Billroth I. This technique is performed after a gastrectomy, or the complete or partial removal of the stomach. A Billroth I procedure restores normal gastrointestinal physiology and preserves the duodenal passage. This procedure is often recommended for patients with benign diseases in the gastrointestinal system.
Billroth II. This procedure involves the creation of a connection between the stomach and the jejunum, another section of the small intestine. A Billroth II procedure is recommended for patients unsuited for a Billroth I. This involves fewer modifications to biliary and pancreatic functions, and has shown to decrease the occurrence of stomach inflammation and ulceration.
Who Should Undergo and Expected Results
Gastroduodenostomy is recommended for patients with:
Stomach cancer. Also known as gastric cancer, this condition develops from the lining of the stomach. Patients often experience early symptoms such as loss of appetite, pain in the upper abdominal area, heartburn, and nausea. Over time, the patient experiences difficulty in swallowing, bloody stools, severe weight loss, and a yellow hue to the skin and the sclera. When left unchecked, the cancer can metastasize to the bones, liver, lungs, the lining of the abdominal cavity, and the lymph nodes. Surgical procedures such as gastroduodenostomy (Billroth I and Billroth II) remain to be the only curative therapy for this condition.
Peptic ulcers. Also known as stomach ulcers, this condition involves sores in the lining of the stomach or the duodenum. Peptic ulcers often manifest through symptoms such as pain the upper or middle stomach in between meals or at night, heartburn, nausea, vomiting, and bloating. Severe forms of the condition can entail severe weight loss, severe abdominal pain, vomiting blood (which can appear as tiny spots resembling coffee grounds), and black stools that result from bleeding of the ulcers. Though most ulcers will heal and go away on their own, serious ulcers can cause internal bleeding, a perforation in the stomach wall, and gastric outlet obstruction. A gastroduodenostomy will be required in the event of serious peptic ulcer disease, especially when the condition has caused a perforation in the stomach wall and serious bleeding that cannot be addressed by an endoscopic treatment.
Gastric outlet obstruction. This condition involves an obstruction located in the pyloric valve, an outlet of the stomach. Symptoms of this condition include vomiting (of food that accumulated in the stomach, because its passage to the small intestine is obstructed), dehydration, and severe weight loss. Significant gastric outlet obstruction can require a gastroduodenostomy, but not as the first line of treatment. The surgical procedure will only be performed when other forms of treatment have failed to improve the situation. The Billroth I procedure will bypass the obstructed pylorus and connect the patient’s stomach directly to the small intestine through the duodenum.
Gastritis. This condition involves the inflammation of the stomach lining. Mild cases respond to lifestyle and habit changes, but chronic gastritis can cause serious complications, including peptic and bleeding ulcers, renal malfunction, bowel obstruction, and in severe cases, death.
How Does the Procedure Work?
The gastroduodenostomy procedure is performed under general anaesthesia, which means that the patient is asleep during the entire operation and will not feel pain. The surgeon will make an incision in the abdomen to gain access to the stomach. A piece of the stomach will be removed, and the surgeon will reconnect the organ to the rest of the small intestines. In a Billroth I procedure, the surgeon will connect the stomach to the duodenum, or the first part of the small intestine.
The surgeon will also perform a ligation of the gastric arteries and veins, including the ones that supply blood into the duodenum. The patient’s stomach will be closed first at the level of the lesser curvature. The surgeon must leave an opening for the connection to the duodenum. Stapling equipment can be used in a Billroth I procedure.
After the procedure, the patient will be moved to a recovery room and will receive intravenous fluid and electrolyte therapy until he or she is able to receive nourishment orally.
Possible Risks and Complications
Gastroduodenostomy risks include:
- Post-operative bleeding
- Difficulty swallowing
- Blood clotting
Issues with the surgical wounds
Complications of the procedure include:
Low blood sugar levels, especially after a meal
- Duodenogastric reflux, which can result in persistent vomiting
- Malabsorption of necessary nutrients in patients who also underwent a stomach resection
- Loss of appetite
- Iron-deficiency anemia
- Alkaline reflux gastritis
- Dumping syndrome, which involves symptoms such as diarrhea, lightheadedness, sweating, vomiting, and abdominal pain
- International Foundation for Functional Gastrointestinal Disorders
- National Digestive Diseases Information Clearinghouse
- Johns Hopkins Medicine
- Encyclopedia of Surgery: “Gastroduodenostomy.”