# Dual-Outlet Stomach-Partitioning Gastrojejunostomy for Malignant Duodenal Obstruction: A Novel Palliative Bypass Technique

## TL;DR

A new surgical technique called dual-outlet stomach-partitioning gastrojejunostomy is introduced to treat blockages in the lower part of the duodenum caused by cancer.

## Contribution

The novel DO-SPGJ technique adds a second anastomosis to address fluid stasis in distal duodenal obstruction cases.

## Key findings

- The dual-anastomosis approach allows food bypass and drainage of digestive secretions.
- The technique may reduce complications like cholangitis or pancreatitis caused by fluid stagnation.
- DO-SPGJ is a viable option for unresectable malignant distal duodenal obstruction.

## Abstract

Stomach-partitioning gastrojejunostomy (SPGJ) is widely performed for malignant gastric outlet obstruction; however, its utility may be limited when the obstruction is located in the distal duodenum, where digestive fluid stasis can become problematic. We devised a novel modification, termed dual-outlet stomach-partitioning gastrojejunostomy (DO-SPGJ), to address this limitation by adding a 2nd gastrojejunostomy distal to the gastric partition.

A 67-year-old man with a tumor in the 3rd portion of the duodenum was diagnosed with squamous cell carcinoma without distant metastasis. The tumor was deemed unresectable due to invasion of the superior mesenteric artery. After 2 months of systemic chemotherapy, the patient developed symptoms of gastric outlet obstruction. A laparoscopic modified SPGJ was performed, involving a standard proximal gastrojejunostomy and an additional distal anastomosis between the gastric antrum and jejunum. The postoperative course was uneventful, and oral intake was successfully resumed.

This dual-anastomosis approach allows for both food bypass and drainage of digestive secretions, addressing the limitation of conventional SPGJ in cases of distal duodenal obstruction. The technique may also mitigate complications related to fluid stagnation, such as cholangitis or pancreatitis. This novel technique may represent a viable surgical option for select patients with unresectable malignant obstruction of the distal duodenum, especially when fluid stasis is a concern.