Esophagojejunostomy

In fact, not all organs in many people's bodies are healthy. Sometimes, due to previous injuries or compression, severe local inflammation may occur. Coupled with local separation, esophageal jejunostomy is needed to relieve the symptoms. Before the operation, it is necessary to pay attention to emptying the stomach. Only in this way can the operation be completed. Otherwise, some food will be in the stomach, making it difficult to perform the operation.

Surgery Name

Subtotal gastrectomy with Roux-en-y jejunostomy

Aliases

Roux-Y gastrojejunostomy after subtotal gastrectomy

Classification

Thoracic Surgery/Esophageal Surgery/Surgical Treatment of Gastroesophageal Reflux Disease/Surgical Treatment of Reflux Esophagitis

ICD codes

43.7 05

Overview

For severe reflux esophagitis and those with excessive stomach acid, surgery to reduce acid and accelerate gastric emptying is a more thorough treatment method. The lower esophageal and subtotal gastrectomy and Roux-en-y jejunostomy are one of the classic methods. Subtotal gastrectomy can reduce the secretion of gastric acid and pepsin, promote rapid emptying of gastric contents, reduce reflux, and thus treat reflux esophagitis.

Indications

Subtotal gastrectomy with Roux-en-y jejunostomy is indicated for:

1. Patients with reflux esophagitis with severe reflux of gastric contents and excessive secretion of gastric acid and pepsin.

2. Patients with reflux esophagitis and irreversible stenosis of the lower esophagus.

3. Patients with reflux esophagitis combined with gastric and duodenal ulcers who require surgical treatment.

Contraindications

1. Those whose heart, lung, liver, and kidney functions cannot withstand this surgery.

2. Poor nutritional status and low hemoglobin (<60g/L).

3. There are extensive adhesions in the abdominal cavity, and it is estimated that it will be difficult to free the intestines.

4. People with active intestinal diseases.

Preoperative preparation

1. For those with poor nutritional status, dietary therapy should be actively implemented, antacid preparations should be given, and small amounts of fresh blood should be transfused multiple times to keep the hemoglobin level not lower than 100g/L.

2. If there are symptoms of pyloric obstruction, gastric lavage should be performed before surgery to prevent the gastric mucosa from being in an acute inflammatory state.

Anesthesia and positioning

1. Anesthesia: Endotracheal intubation, general anesthesia.

2. Lie on your back with the left hypochondrium raised 20 degrees.

Points to note during surgery

1. When freeing the esophagus, be careful not to damage the contralateral pleura and thoracic duct.

2. The jejunoesophageal anastomosis should be well aligned, with the mucosa and muscle (seromuscular) layers aligned neatly.

3. In jejunogastric anastomosis, pay attention to the "triangle area" on the gastric side of the anastomosis, that is, the triangle area between the jejunogastric anastomosis and the closed opening, because fistula is more likely to occur in this area.

4. For pleural symphysis incision, special attention should be paid to the suture of the costal arch. If necessary, part of the cartilage of the costal arch can be removed to ensure a tight suture.

5. Check the patency of each anastomosis, which should not be too narrow.