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Laparoscopic modified Devine exclusion gastrojejunostomy as a palliative surgery to relieve malignant pyloroduodenal obstruction by unresectable cancer.

Suzuki O, Shichinohe T, Yano T, Okamura K, Hazama K, Hirano S, Kondo S

Department of Surgical Oncology, Hokkaido University, Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, 060-8648, Japan. onsuzuki@med.hokudai.ac.jp

BACKGROUND: Malignant pyloroduodenal obstruction by an unresectable cancer makes ingesting food or liquids impossible for patients. The patient's quality of life deteriorates rapidly, leading to a dismal prognosis. The modified Devine exclusion (MDE) method of open laparotomy has been reported to be effective in such cases. METHODS: We performed laparoscopic MDE gastrojejunostomy in 8 cases. The patient data collected included surgical time, morbidity and mortality, length of stay, the state and duration of adequate oral ingestion, and outcome. RESULTS: The median surgical time was 191 minutes. There were no complications postoperatively. The median postoperative stay was 7 days. In that time, feeding conditions were restored to pre-illness levels. All patients were palliated successfully using this procedure. CONCLUSIONS: Laparoscopic MDE gastrojejunostomy allows patients to regain their ability to eat, significantly improving their quality of life. This alternative laparoscopic procedure is effective for patients whose prognosis is poor as a result of unresectable cancer.

Published 13 August 2007 in Am J Surg, 194(3): 416-8.
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