Top

Journal of Gastrointestinal Surgery

Published in:

01-07-2009 | Original Article

Modified Devine Exclusion with Vertical Stomach Reconstruction for Gastric Outlet Obstruction: A Novel Technique

Authors: Takatsugu Oida, Kenji Mimatsu, Atsushi Kawasaki, Hisao Kano, Youichi Kuboi, Sadao Amano

Published in: Journal of Gastrointestinal Surgery | Issue 7/2009

Abstract

Background

A gastroenterostomy is the most commonly performed palliative procedure in patients with gastroduodenal outflow obstruction (GOO) caused by unresectable advanced gastric and pancreatic cancer. We developed a new technique—modified Devine exclusion with vertical stomach reconstruction—and evaluated the efficacy of this procedure.

Methods

We retrospectively studied 60 patients who underwent gastrojejunostomy for GOO caused by unresectable advanced gastric and pancreatic cancer. These patients were divided into two groups, the conventional gastrojejunostomy group (CGJ group) and the modified Devine exclusion with vertical stomach reconstruction group (MDVSR group).

Results

The mean duration of the required nasogastric suction, the number of days after which diet could be initiated and after which oral ingestion of solid food could by safely resumed, and the duration of hospitalization after the surgery were significantly shorter in the MDVSR group. The patients in the MDVSR group had a significantly longer duration of stay at home and survival after the surgery. Moreover, in the MDVSR group, GOO did not recur in any of the patients until the time of death.

Conclusion

We consider that our procedure of modified Devine exclusion with vertical stomach reconstruction is an easy and feasible technique for GOO.

Bozzetti F, Bonfanti G, Audisio RA, Doci R, Dossena G, Gennari L, Andreola S. Prognosis of patients after palliative surgical procedures of carcinoma of the stomach. Surg Gynecol Obstet 1987;164:151–154.PubMed

de Rooji PD, Rogakto A, Brennan MF. Evaluation of palliative surgical procedures in unresectable pancreatic cancer. Br J Surg 1991;78:1053–1058. doi:10.1002/bjs.1800780909.CrossRef

Woods SDS, Miitchell GJ. Delayed return of gastric emptying after gastroenterostomy. Br J Surg 1989;76:145–148. doi:10.1002/bjs.1800760213.PubMedCrossRef

Lo NN, Kee SG, Nambiar R. Palliative gastrojejunostomy for advanced carcinoma of the stomach. Ann Acad Med Singap 1991;20:356–358.PubMed

Devine HB. Basic principle and supreme difficulties in gastric surgery. Surg Gynecol Obstet 1925;40:1–16.

Mimatsu K, Oida T, Kuboi Y, Kawasaki A, Kanou H, Kaneda H, Amano S. A long-surviving patient with unresectable advanced gastric cancer responding to S-1after receiving improved gastrojejunostomy. Int J Clin Oncol 2004;9:193–196.PubMedCrossRef

Yeo CJ, Barry MK, Sauter PK, Sostre S, Lillemore KD, Pitt HA, Cameron JL. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy: A prospective, randomized, placebo-controlled trial. Ann Surg 1993;218:229–237.PubMedCrossRef

Rhodes M, Nathanson L, Fielding G. Laparoscopic biliary and gastric bypass: A useful adjunct in the treatment of carcinoma of the pancreas. Gut 1995;36:778–780.PubMedCrossRef

Kuriansky J, Saenz A, Astudillo E, Cardona V, Fernandes-Cruz L. Simultaneous laparoscopic biliary and retrocoric gastric bypass in patients with unresectable carcinoma of the pancreas. Surg Endosc 2000;14:179–181.PubMedCrossRef

10.

Choi YB. Laparoscopic gastrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer. Surg Endosc 2000;16:1620–1626.CrossRef

11.

Kaminishi M, Yamaguchi H, Shimizu N, Nomura S, Yoshikawa A, Hashimoto M, Sakai S, Oohara T. Stomach-partitioning gastrojejunostomy for unresectable gastric carcinoma. Arch Surg 1997;132:184–187.PubMed

12.

Ammori BJ, Boreham B. Laparoscopic Devine exclusion gastroenterostomy for the palliation of unresectable and obstructing gastric carcinoma. Surg Laparosc Endosc Percutan Tech 2002;12:353–355.PubMedCrossRef

13.

Suzuki O, Shichinohe T, Yano T, Okamura K, Hazama K, Hirano S, Kondo S. Laparoscopic mofdified Devine exclusion gastrojejunostomy as a palliative surgery to relieve malignant pyloroduodenal obstruction by unresectable cancer. Am J Surg 2007;194:416–418.PubMedCrossRef

14.

Kato K, Morita T, Miyasaka Y, Fujita M, Kondo S, Katoh H. Modified Devine exclusion for unresectable pancreatic head carcinoma. Hepatogastroenterology 2001;48:569–571.PubMed

15.

Kazanjian Kk, Reber HA, Hines OJ. Laproscopic gastrojejunostomy for gastric outlet obstruction in pancreatic cancer. Am Surg 2004;70:910–913.PubMed

16.

Doberneck RC, Berndt GA. Delayed gastric emptying after palliativegastrojejunostomy for cancer of the pancreas. Arch Surg 1987;122:827–829.PubMed

17.

Koizumi W, Kurihara M, Nakano S. Phase II study of S-1, a novel oral derivative of 5-fluorouracil, in advanced gastric cancer. Oncology 2000;58:191–197.PubMedCrossRef

18.

Glimelius B, Hoffman K, Haglund O, et al. Initial or delayed chemotherapy with best supportive care in advanced gastric cancer. Ann Oncol 1994;5:189–190.PubMed

19.

Kwok SPY, Chung SCS, Griffin SM, Li AKC. Devine exclusion for unresectable carcinoma of the stomach. Br J Surg 1991;78:684–685.PubMedCrossRef

Title: Modified Devine Exclusion with Vertical Stomach Reconstruction for Gastric Outlet Obstruction: A Novel Technique
Authors: Takatsugu Oida
Kenji Mimatsu
Atsushi Kawasaki
Hisao Kano
Youichi Kuboi
Sadao Amano
Publication date: 01-07-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 7/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0874-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Modified Devine Exclusion with Vertical Stomach Reconstruction for Gastric Outlet Obstruction: A Novel Technique

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2009

Comparison of Clinical Effects Between Warm Water Spray and Sitz Bath in Post-hemorrhoidectomy Period

Mechanical Bowel Preparation for Elective Colorectal Surgery: Is it Enough?

The Ancient Technique of “Gastrorrhaphy”

A Simple Scoring System Based on Clinical Features to Predict Locally Advanced Rectal Cancers

Predictive Factors for Exocrine Pancreatic Insufficiency After Pancreatoduodenectomy with Pancreaticogastrostomy

National Trends and Outcomes for the Surgical Therapy of Ileocolonic Crohn’s Disease: A Population-Based Analysis of Laparoscopic vs. Open Approaches