Gastrojejunostomy

Alternative to pyloroplasty in obstructing duodenal ulcer (more effective) and less morbid than antrectomy.

Need to add vagotomy to prevent marginal ulceration

Upper midline incision
Clear dependent portion of greater curvature of omentum
Divide gastroepiploic arcade
Retrocolic probably gives better functional result
Clear window in mesentery, usually to left of middle colics
Usual anatomosis
Once complete, pull anastomosis back through mesocolon, then tack stomach to transverse mesocolon to prevent slippage
If chronically distended stomach, consider tube gastrostomy to avoid long term NG

POST OP
Maintain on PPI to prevent marginal ulceration