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Gastrojejunostomy refers to a surgical procedure of the gut. There are various techniques which arrive at the same end result, which is food bypassing the exit of the stomach and the duodenum (the first part of the small intestine), to arrive directly in the small intestine (jejunum).
A gastrojejunostomy is indicated if there is a blockage to the outflow of the stomach or if the duodenum is damaged such that it cannot process food. It is an uncommon procedure, but doesn't require specialist equipment and may be undertaken in first opinion practice where the surgeon has the appropriate skills.
Gastrojejunostomy is most commonly used as a salvage procedure, where other methods of correcting the underlying problem have been tried and failed. Although there is a risk of complications, the outcome is usually good.
Each case is carefully assessed to ensure there are no other options to correct the underlying issue, such as excision of the stomach cancer. Once it is confirmed gastrojejunostomy is the procedure of choice, the dog is prepared for surgery.
Prior to a general anesthetic, the dog is given pain relief and a premed injection. Depending on the underlying cause of the problem, they may also receive intravenous antibiotics and antacid medications.
The dog is placed on their back and the belly clipped and scrubbed. Under aseptic conditions, the surgeon makes an incision into the dog's abdomen. The stomach and small intestine are identified and isolated from the rest of the abdomen using sterile packing swabs. Stay stitches are placed in both the stomach and the jejunum to facilitate handling.
With the jejunum held in apposition to the stomach, a corresponding incision is made in both. The wound edges of the stomach are sutured to those of the jejunum so that a new exit from the stomach into the jejunum is formed. The stoma is checked for leaks.
Then the abdomen is closed in three layers and the dog woken from the anesthetic. Water is initially offered by mouth for the first 24 hours. After that liquidised food is given in small quantities every few hours, for around 5 days, when soft food is given.
The skin sutures are removed after 10 to 14 days. Depending on the nature of the original condition, a soft diet may be required for life.
Gastrojejunostomy is a clever procedure because it facilitates solid food moving past a bottleneck, whilst still allowing bile and pancreatic secretions to enter the duodenum and mix downstream with the ingesta.
The technique described above is a permanent procedure that does not involve the use of feeding tubes. Thus, within the dietary needs of the individual, the patient is able to eat normally.
An alternative technique involves passing a feeding tube through the body wall and into the stomach. The tube is then advanced through the narrowed pylorus, down the duodenum and into the jejunum. The patient is then fed via the feeding tube, with the nutrition bypassing the stomach and arriving direct into the small intestine. This can be beneficial for patients with generalized, severe stomach ulcers. However, the patient then becomes dependent on being tube fed a liquid diet.
Patients commonly vomit blood for 24 hours post-surgery, and are therefore monitored in intensive care. Antacid medication, antibiotics, and pain relief are given as indicated, in order to reduce the risk of complications such as stomach ulcers, infection, or severe discomfort.
Provided all goes well, most patients can be discharged two to three days post-surgery, provided the owner feels confident about how to feed the dog.
Gastrojejunostomy is liable to cost $1,000 to $3,000 depending on the surgical time and the cost of intensive care postoperatively. Other procedures, such as placing a gastrojejunostomy tube, are less invasive but require specialist equipment and therefore may not be any less expensive. In addition, a feeding tube needs careful maintenance, and complications from leakage where the tube enters the gut can mean a risk of complications.
Gastrojejunostomy is major surgery but can be life-transforming in certain patients. Whilst the procedure is not curative (when used in cases with stomach cancer) it allows the dog to eat normally, reduce the amount of vomiting, and promote a better quality of life.
The procedure carries a high success rate but, as with any bowel surgery, there is the potential for complications. This includes wound breakdown along the stomach site, with leakage of gut contents into the abdomen, and peritonitis. This would require repeat surgery to flush out the abdomen and repair the failed stoma.
Stomach ulcers can arise after the inappropriate use of NSAIDs (non-steroidal anti-inflammatory medication) or corticosteroids. Giving these medications on an empty stomach greatly increases the risk of gastric ulceration, so they should always be given with food.
Even when a gastric ulcer develops, it may be possible to avoid surgery by using a combination of antacid and gastro-protective drugs, in order for the stomach wall to repair.
Also, owners should be careful and prevent their pets getting access to very hot food. Hot sausages stolen from a barbecue can be swallowed and then burn the stomach, causing scar tissue to form.
Stomach cancer is rare. It is suspected there is a link to long term exposure to certain nitrite pickling salts, so foodstuffs containing nitrosamines is best avoided. There is also an increased risk of stomach cancer in the German Shepherd breed, but this is due to genetic factors and outside an owner's control.
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