subtotal gastrectomy with gastrojejunostomy surgical overview

1. SUBTOTAL GASTRECTOMY WITH
GASTROJEJUNOSTOMY
DR. ATUL KHARE

2. OUTLINE OF PRESENTATION
• SURGICAL ANATOMY
• INDICATION
• PREOPERATIVE EVALUATION
• SURGICAL TECHNIQUE
• COMPLICATIONS AND ITS MANAGEMENT

3. ANATOMY

7. • Y

8. OPERATIVE STEPS

9. OPERATIVE STEPS

10. INTRAOPERATIVE COMPLICATIONS
INTRAOPERATIVE
1] HAEMORRHAGE
2] ACUTE ISCHEMIA OF LEFT LOBE OF LIVER
3] INJURY TO SPLEEN, PANCREAS, COMMON BILE DUCT
4] DISRUPTION OF AMPULLA OF VATER

11. IMMEDIATE COMPLICATIONS
IMMEDIATE
1] ATELECTASIS
2] PNEUMONIA
3] RESPIRATORY FAILURE
4] PULMONARY EMBOLISM
5] DEEP VENOUS THROMBOSIS
6] WOUND INFECTION
7] SUB PHRENIC ABSCESS
8] ACUTE PANCREATITIS

12. EARLY COMPLICATIONS
1] POST OPERATIVE ANASTOMOTIC HAEMORRHAGE
2] ANASTOMOTIC LEAK
3] DUODENAL STUMP LEAK
4] SMALL BOWEL OBSTRUCTION
5] STOMAL OBSTRUCTION

13. LATE COMPLICATIONS
1] ANASTOMOTIC STRICTURE
2] MARGINAL ULCER BLEEDING
3] GASTRO-GASTRIC FISTULA
4] POST-GASTRECTOMY SYNDROME=
-GASTRIC RESERVOIR DYSFUNCTION [ DUMPING SYNDROME, METABOLIC DISORDERS ]
-VAGAL DENERVATION’S [ DIARRHOEA, GASTRIC STASIS, GALLSTONE]
-ABERRATIONS IN SURGICAL RECONSTRUCTION [ ALKALINE REFLUX GASTRITIS, AFF AND
EFF LOOP OBSTRUCTION, ROUX SYNDROME ]
5] SMALL STOMACH SYNDROME
6] STUMP CARCINOMA

14. THANK YOU