Category: Gastrointestinal Surgery
Procedure: Gastrojejunostomy (GJ)
Approach: Open • Stapled
A practical guide written from the perspective of an Operating Room Nurse.
The workflows, surgeon preferences, and nursing tips presented in this article are based on the author’s real clinical experience. Surgical techniques and operating room practices may vary depending on the surgeon, hospital, and institutional protocols.
What is Gastrojejunostomy?
Gastrojejunostomy (GJ) is a reconstructive gastrointestinal procedure that creates a direct anastomosis between the stomach and the jejunum.
Instead of allowing gastric contents to pass through the pylorus and duodenum, food bypasses the obstructed segment and enters the proximal jejunum.
This operation is frequently performed as a palliative bypass for gastric outlet obstruction or as part of gastric surgery.
For operating room nurses, understanding the sequence of bowel mobilization, anastomotic creation, stapler handling, and leak assessment is essential for smooth intraoperative assistance.
📌Quick Facts
| Item | Information |
|---|---|
| Procedure | Gastrojejunostomy |
| Abbreviation | GJ |
| Specialty | General Surgery |
| Organ | Stomach / Jejunum |
| Position | Supine |
| Anesthesia | General |
| Approach | Open / Laparoscopic |
| Anastomosis | Side-to-side |
| Reconstruction | Gastric bypass |
| Typical Duration | 2–4 hours |
Surgical Indications
Gastrojejunostomy is primarily indicated when gastric emptying through the pylorus is no longer possible due to advanced gastric disease or obstruction.
Typical indications include:
- Gastric outlet obstruction
- Advanced gastric cancer
- Duodenal obstruction
- Palliative bypass
- Selected benign strictures
Contraindications
Relative contraindications include:
- Diffuse bowel ischemia
- Severe peritoneal contamination
- Unstable patients unable to tolerate major abdominal surgery
Relevant Anatomy
Every OR nurse should identify the following structures:
- Stomach
- Greater curvature
- Lesser curvature
- Pylorus
- Ligament of Treitz
- Proximal jejunum
- Mesentery
- Gastroepiploic vessels
Correct identification prevents twisting of the jejunal limb and tension on the anastomosis.
Patient Position
The patient is positioned supine under general anesthesia.
Preparation includes:
- Arms secured
- Foley catheter if indicated
- NG tube depending on surgeon preference
- Sequential compression devices
- Skin preparation from nipple line to mid-thigh
🕒Surgical Workflow
Step 1 — Abdominal Entry
Open
- Midline incision
- Abdominal exploration
- Evaluate resectability
- Confirm indication for bypass
Step 2 — Identify the Jejunum
The jejunum is located distal to the Ligament of Treitz.
The surgeon selects an appropriate bowel loop that reaches the stomach without tension.
Step 3 — Select the Gastric Site
The anterior wall of the stomach is generally chosen.
The bowel should naturally align with the stomach.
Avoid:
- Excessive tension
- Rotation
- Mesenteric twisting
Step 4 — Create Enterotomies
Small openings are made in:
- stomach
- jejunum
These become the common channel.
Step 5 — Anastomosis
Method 1
Open Hand-Sewn
- Posterior seromuscular layer
- Full-thickness inner layer
- Continuous or interrupted closure
- Lembert reinforcement
Method 2
Open Stapled
- Linear stapler inserted
- Fire stapler
- Close common opening
- Reinforce staple line
Advantages
- Faster
- Uniform lumen
- Less operative time
Step 6 — Leak Inspection
The surgeon checks
- bleeding
- staple line
- lumen
- bowel orientation
- tension
Step 7 — Irrigation and Closure
After confirming hemostasis
- irrigation
- drain (if required)
- fascial closure
- skin closure
🕒Procedure Timeline
| Phase | Key Action |
|---|---|
| Patient Preparation | Anesthesia / Position |
| Exposure | Midline incision or trocar insertion |
| Identification | Stomach + Jejunum |
| Enterotomy | Create openings |
| Anastomosis | Hand-sewn or Stapled |
| Leak Test | Bleeding / Patency |
| Closure | Irrigation + Closure |
Mayo Stand Setup
Cutting
- #10 Blade
- #15 Blade
- Metzenbaum
- Mayo Scissors
Grasping
- Adson Forceps
- DeBakey Forceps
- Russian Forceps
Hemostasis
- Mosquito
- Kelly
- Crile
Clamping
- Babcock
- Allis
- Kocher
Needle Holders
- Mayo-Hegar
- Ryder
Suction
- Yankauer
- Poole
Back Table Setup
Major instruments
- Major Laparotomy Set
- Bowel Set
- Self-retaining Retractor
- Bookwalter System
- Linear Stapler
- TA Stapler (if requested)
- Stapler Reloads
- Suction Tubing
- Electrocautery
- Ligasure / Harmonic (laparoscopy)
Sutures Commonly Used
both hand-sewn and stapled anastomoses with seromuscular reinforcement.
Examples commonly prepared in the OR include:
| Layer | Suture |
|---|---|
| Inner | Vicryl 3-0 |
| Outer | Silk 3-0 |
| Laparoscopic Closure | Barbed suture |
| Reinforcement | PDS |
(Specific suture selection depends on surgeon preference.)
Stapling Devices
Frequently requested
- GIA Linear Stapler
- Linear Cutter
- Reloads
- TA Stapler
✅30-Second OR Checklist
Before anastomosis
✅Correct bowel loop
✅ No mesenteric twist
✅ Adequate reach
✅ Stapler ready
✅ Correct reload
✅ Suction available
✅ Needle count correct
✅ Additional Vicryl prepared
✅ Silk ready for reinforcement
✅ Leak test discussed
⚠️Common Pitfalls
Twisted Jejunal Limb
Can cause obstruction.
Excessive Tension
May increase leak risk.
Small Anastomosis
May predispose to postoperative narrowing.
Stapler Misfire
Always verify:
- reload color
- tissue thickness
- jaw closure
Bleeding
Inspect both
- staple line
- mesenteric edge
💎OR Nurse Pearls
These practical points are based on general operating room practice rather than the uploaded textbook.
- Always prepare extra stapler reloads before the first firing.
- Keep suction available during enterotomy creation.
- Expect reinforcement sutures after stapled anastomosis.
- Watch bowel orientation continuously.
- Confirm counts before abdominal closure.
- Anticipate additional hemostatic agents if minor staple-line bleeding occurs.
Possible Complications
- Anastomotic leak
- Bleeding
- Delayed gastric emptying
- Ileus
- Internal hernia
- Wound infection
- Intra-abdominal abscess
- Anastomotic stricture
Postoperative Care
Typical postoperative priorities include:
- NG tube management (if used)
- Pain control
- Early ambulation
- Monitoring for signs of leakage
- Diet advancement according to bowel function
- Drain assessment when present
Frequently Asked Questions
What is the purpose of Gastrojejunostomy?
To bypass an obstructed gastric outlet and restore gastrointestinal continuity.
Why is the jejunum selected?
The jejunum provides a mobile, well-vascularized segment suitable for creating a tension-free anastomosis.
What should the scrub nurse pay close attention to?
Instrument readiness, stapler preparation, bowel orientation, reinforcement sutures, and accurate surgical counts.
Key Takeaways
- Gastrojejunostomy creates a bypass between the stomach and jejunum.
- three operative approaches: open hand-sewn, open stapled, and laparoscopic stapled anastomosis.
- A tension-free, well-vascularized anastomosis is critical.
- OR nurses should anticipate stapler use, reinforcement sutures, leak assessment, and final inspection.
- Careful preparation and instrument organization contribute to a safe and efficient operation.
📚Related Articles
🔗 Intestinal Anastomosis: Understanding Small Bowel Resection and Anastomosis
🔗 Vagotomy: Surgical Technique, Anatomy, and Operating Room Guide