jejunojejunostomies

Jejunojejunostomy is a surgical anastomosis between two segments of the jejunum. It is performed to restore intestinal continuity after resection of a diseased jejunal segment or to create a bypass circuit within the small intestine. In bariatric and alimentary tract surgery, a jejunojejunostomy is a component of procedures such as Roux-en-Y, where the biliopancreatic and alimentary limbs are joined to form a Y configuration; this anastomosis sits distal to the gastrojejunostomy. Outside of bariatrics, jejunojejunostomies are used to reanastomose the jejunum after segmental resection due to trauma, ischemia, Crohn disease, or tumor.

Techniques used for jejunojejunostomy include end-to-end, end-to-side, and side-to-side configurations. The anastomosis may be constructed with hand-sewn sutures or stapling devices. Important technical considerations include thorough debridement of nonviable tissue, precise alignment of serosal and mucosal surfaces, achieving an adequate lumen size, and creating a tension-free connection to reduce leak risk. The choice of technique and configuration depends on the surgeon’s preference and the specific clinical scenario.

Complications associated with jejunojejunostomy can include anastomotic leak, bleeding, stricturing or obstruction at the anastomosis, and fistula formation. Additional risks include infection, intra-abdominal adhesions, and, in certain Roux-en-Y configurations, internal hernia due to mesenteric defects. Postoperative management involves monitoring for signs of leakage and obstruction, gradual advancement of diet, and imaging studies if complications are suspected.

Outcomes vary with the underlying disease and the patient’s overall condition, but when performed by experienced surgeons, jejunojejunostomies aim to safely restore intestinal continuity and enable recovery.