Iftikhar Mohammad Khan, Zainab Rehman, Parkha Rehman.
the role of prophylactic gastrojejunostomy in un-resectable peri-ampullary carcinomas.
Pak J Surg Jan ;34(3):205-9.

Objectives: To evaluate the role of prophylactic gastrojejunostomy in preventing late gastric outlet obstruction in patients with advanced periampullary tumors. Material and Methods: This case series study was conducted at Surgical ward of Khyber Teaching Hospital Peshawar from January 2014 to December 2017 and included 33 patients with advanced unresectable periampullary carcinoma. They underwent prophylactic retrocolicgastrojejunostomy alone or in combination with a biliodigestive procedure. Patients with resectable tumors and those with previous history of gastric surgery were excluded from this study. Results: Out of these patients 20 patients were males and 13 were females with mean age of 59.78± 5.97. All patients underwent ultrasound and CT scan and 10 patients had pre-op ERCP. Retrocolic-gastrojejunostomy was performed after the tumor was found unresectable. Wound infection was the commonest complication which occurred in 7 patients, common in those with co-morbidities. Biliary leakage occurred in 5 patients, 3 of these patients had pre-operative biliary intervention. Post-operative cholangitis occurred in 3 patients while 4 patients had minor leak from the drain site which improved with conservative management. Four patients developed urinary tract infection, while three patients had signs of delayed gastric emptying which responded to conservative treatment. The mean hospital stay was 8.09±3.39 days and there was no mortality and no patient developed gastric outlet obstruction during the minimum follow up period of 2 months. Conclusion: Prophylactic gastrojejunostomy in patients with unresectable peri-ampullary tumor is a safe procedure with negligible morbidity and mortality and significantly decreases the risk of late gastric outlet obstruction.

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