It is important to understand and study the trends in the incidence of various factors responsible for gastric outlet obstruction in the present scenario and outline the rationale behind treatment of gastric outlet obstruction by open and laparoscopic method.
Method: This is a prospective study of 70 patients diagnosed as GOO .We observed all case of GOO, but to minimize the bias in comparison of Open Gastrojejunostomy and Lap Assisted Gastrojejunostomy due to disease condition, we included those 30 patients of post corrosive ingestion pyloric stenosis for comparison between two operations. We also observed the nature of corrosive injury to stomach. Intra operative findings and postoperative complications were noted.
Results: We observed that benign etiology was more common for GOO (58%) compared to malignant cause (42%) and post corrosive ingestion pyloric stenosis was most common benign cause(42%) of GOO, Pancreatic cancer was most common malignant cause(18.5%) of GOO. Corrosive ingestion was more common in younger age group (66% in 15 -30 yr age) and female gender(63.34%) and mostly as a suicidal attempt(86.66%) and most common corrosive agent was sanitary cleansing agent(hydrochloric acid) (70%).Postprandial nonbillious vomiting and weight loss were consistent symptom and appeared after 6-8 week of corrosive ingestion and 50% of patient of post corrosive ingestion pyloric stenosis had concomitant esophageal stricture. In present study those patient operated with Lap Assisted Gastrojejunostomy had smaller size of incision, reduce intra operative need of blood transfusion, less post-operative pain and less chance of wound infection, early drain and suture removal and early discharged from hospital with minimal post-operative morbidity and without significant increase in total duration and cost of operation.
Conclusion : As compared to Open Gastrojejunostomy, Lap Assisted Gastrojejunostomy is better alternative operative method for pyloric stenosis.
Gastric outlet obstruction, Pyloric stenosis, Lap.Assisted Gastrojejunostomy, Open Gastrojejunostomy, Corrosive ingestion.