Bypass surgery may be carried out either:
- Shortly after diagnosis when it is found during an operation to remove the tumour that it has progressed more than suggested by the pre-operation staging investigations, or
- At a later stage, when a blockage occurs, making you sick because your stomach is not emptying properly.
This is caused by a blockage at the outlet of the stomach where it joins the duodenum (the first part of the small bowel). This blockage is called “gastric outlet obstruction”. Gastric outlet obstruction often develops gradually with discomfort after eating, which is often relieved by vomiting. Fluids are better tolerated than solids but, because the stomach gradually stretches, vomiting may only occur once every few days. Weight loss is common, because food eaten cannot reach the part of the intestine where it is absorbed.
An operation may be required called a “gastro-jejunostomy”. You will have a general anaesthetic and your surgeon may use keyhole surgery (a “laparoscopy”) or make a small incision in your stomach called a “mini-laparotomy”. In order to bypass the duodenum, he/she will then connect another piece of the small bowel, called the “jejunum”, directly to the stomach. Recovery from a gastro-jejunostomy is usually fairly quick. You will be able to start drinking fluids the evening after your operation and gradually start to eat foods. You should be able to go home two or three days after your operation, once you are able to eat and drink without any problems.
After a bypass operation
You may be cared for in a High Dependency Unit (HDU) before going back to the ward. You may be able to start drinking fluids in the evening after your operation and gradually start to eat foods. You will be able to go home once your eating and drinking has improved.
Double Bypass Surgery
This operation is usually carried out during a planned attempt to remove a tumour. If your surgeon discovers that taking out that part of the pancreas with the tumour in it will only remove most, but not all, of the tumour, there is no advantage to you from a partial removal. Continuing with the operation to remove the tumour, but leaving some behind, will delay or prevent more appropriate treatment (e.g. chemotherapy). The aim is then to allow you to recover as quickly as possible, so that more appropriate treatment can be started as soon as possible, whilst at the same time making sure that your liver and stomach continue to work properly during future treatment.
The surgeon will join the bile duct directly to part of the small bowel called the “jejunum”. This allows the bile to flow from the liver into the small bowel and, in time, your jaundice should fade. At the same time your surgeon will connect a piece of small bowel to the stomach, in order to bypass the duodenum. This will allow your stomach to empty properly and should prevent blockage of the duodenum at a later stage.
After a double bypass operation
You may be cared for in a High Dependency Unit (HDU) before going back to the ward. You may be able to start drinking fluids in the evening after your operation and gradually start to eat foods. You will be able to go home once your eating and drinking has improved and your jaundice is getting better.
Duodenal Stent Insertion
An alternative to a stomach bypass operation is the insertion of a stent (a small metallic mesh tube), which holds the sides of the duodenum open in a similar fashion to a stent when it is inserted through a blockage in the bile duct. The aim of putting in a stent is to allow food and other substances to pass through the stomach and relieve your nausea and vomiting.
Where will I have a stent put in?
The procedure will be performed in a room in the X-ray department or endoscopy suite.
How long will it take?
The procedure will take approximately 30 minutes to perform.
Will this procedure work?
Stents can be placed successfully in about 94% of patients.
You must not eat or drink anything for several hours before the stent is inserted. (Your nurses will tell you when to stop eating and drinking.) If your vomiting has been severe, you may already have a naso-gastric tube in place, so that the staff can keep your stomach drained.
You will be taken in to the X-ray department or endoscopy suite in your bed, ready for you to be given your intravenous sedation. When you are feeling sleepy, the doctor will pass an endoscope down your throat and put the stent through the blockage using other specialised equipment. When it is all over, you will remain in the department until you are more awake and then return to the ward.
When can I get home?
You will be able to go home when you feel ready. Usually, this is within a few days of the procedure.
Are there any complications?
As with any operation, there is a slight risk of complications happening during or after the procedure. Complications linked with stent insertion include:
- Fluid getting into the lungs during the procedure;
- Puncture of the digestive tract;
- The stent moving; and
- The stent causing an unwanted opening in the digestive tract.
Eating and drinking after the insertion of a stent
Because the stent doesn’t move and is about three to four inches long there is a tendency for solid food to get stuck and consequently, rather than returning to a normal diet, you will be encouraged to take nourishing fluids and soft foods to prevent the stent becoming blocked with food particles. Your dietitian will advise you as to what the most appropriate foods for you.