Background: Surgical relief of gastric outlet obstruction (GOO) or small bowel obstruction in patients
who had undergone major resection or palliative bypass surgery for malignancy is conventionally
achieved at a laparotomy. The potential role of minimally invasive surgery in the management
of these complications has not been previously explored.
Methods: Between 2003 and 2004, 4 consecutive patients, age range 37 to 72 years, where admitted
with gastric outlet or proximal small bowel obstruction following previous open surgery for suspected
intra-abdominal malignancy, under the care of one surgeon. The respective past histories of
these patients were recurrent GOO and concomitant distal biliary obstruction following a previous
open gastric bypass elsewhere for metastatic pancreatic head cancer; persistent adhesive small bowel
obstruction following radical gastrectomy for gastric cancer; GOO secondary to intra-abdominal
recurrence 6 months after hepatobiliary resection for hilar cholangiocarcinoma; and GOO following
previous pancreatico-duodenectomy for suspected pancreatic head cancer. Their respective surgical
management consisted of a laparoscopic re-do gastric bypass and concomitant cholecystojejunostomy;
adhesiolysis and revision of the Roux-en-Y enteric anastomosis; a Devine exclusion
gastroenterostomy; and resection and refashioning of the gastroenterostomy.
Results: There were no conversions to open surgery and no postoperative complications. The median
operating time was 240 minutes (range, 145 to 300 minutes). Oral free fluid intake was resumed
on postoperative day (POD) 1, while diet was resumed between POD 2 and 4. The median
postoperative hospital stay was 15.5 days (range, 14 to 25 days).
Conclusion: Previous laparotomy and major resection or palliation of malignancy do not preclude
the application of the laparoscopic approach for the management of upper gastrointestinal obstruction.
Laparoscopic adhesiolysis and revision of enteroenteric and gastroenteric anastomoses
are feasible management options in the hands of those experienced with complex laparoscopic
surgery.
