A Novel Reconstruction Technique During Pancreaticoduodenectomy After Roux-En-Y Gastric Bypass: How I do It

Younan, George; Tsai, Susan; Evans, Douglas B.; Christians, Kathleen K.

doi:10.1007/s11605-017-3405-2

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Another possible way to utilize the remnant stomach is for reconstruction. Younan et al described a method in which the gastric remnant is preserved and used for pancreaticogastrostomy (PG) reconstruction and subsequently drained by the same jejunal limb used for the HJ (17). Tsamalaidze et al reported that out of seven patients with stomach preservation, the remnant stomach was used for pancreatic reconstruction in three patients and two patients had insertion of transgastric jejunal feeding tube for nutrition (18).…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy after Roux-en-Y Gastric Bypass: a novel reconstruction technique

Mak¹,

Shelat²

2022

Transl Gastroenterol Hepatol

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BackgroundThe obesity epidemic continues to increase around the world with its attendant complications of metabolic syndrome and increased risk of malignancies (1), including pancreatic malignancy (2,3). The Roux-en-Y gastric bypass (RYGB) effectively treats obesity and its associated morbidities including metabolic syndrome (4). RYGB creates a gastric pouch with alimentary limb, as well as a biliopancreatic (BP) limb that joins the alimentary limb to form a common channel. Thus, it has both restrictive and mal-absorptive components. Patients with a mass in the head of pancreas are recommended pancreaticoduodenectomy (PD) for suspected malignancy (5). As bariatric surgery is increasingly adopted in recent years (6), more reports of PD following RYGB are published. Post-surgical adhesions and altered anatomy following RYGB poses not only a diagnostic challenge by making endoscopy difficult, but also unique challenge of reconstruction following PD. There are many different techniques of reconstruction proposed. Here we describe a patient where the remnant BP limb was used for a venting anterior gastrojejunostomy. The pancreaticojejunostomy and hepaticojejunostomy was created with a new loop of jejunum and a new distal jejunojejunostomy was performed. MethodsA 59-year-old male presented with painless obstructive jaundice of one week's duration. He had a history of RYGB

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Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy after Roux-en-Y Gastric Bypass: a novel reconstruction technique

Mak¹,

Shelat²

2022

Transl Gastroenterol Hepatol

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“…Indeed, with both the increasing incidence of pancreatic cancer and number of patients undergoing bariatric procedures, this clinical scenario will become more prevalent, making discussions of the surgical options more frequent and relevant. Furthermore, gastric remnant preservation, while currently performed less frequently, may be advantageous from a multidisciplinary standpoint, but clearly requires further investigation [ 61 ]. Although not discussed, decisions regarding preoperative diagnostic modalities or perioperative neoadjuvant and adjuvant treatments for this unique, but expanding, patient population deserves further review.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

et al. 2018

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BackgroundObesity is a risk factor for pancreatic cancer which may be treated with Roux-en-Y gastric bypass and represents an increasing morbidity. Post-RYGB anatomy poses considerable challenges for reconstruction after pancreaticoduodenectomy (PD), a growing problem encountered by surgeons. We characterize specific strategies used for post-PD reconstruction in the RYGB patient.MethodsPubMed search was performed using MeSH terms “Gastric Bypass” and “Pancreaticoduodenectomy” between 2000 and 2018. Articles reporting cases of pancreaticoduodenectomy in post-RYGB patients were included and systematically reviewed for this study.ResultsThree case reports and five case series (25 patients) addressed PD after RYGB; we report one additional case. The typical post-gastric bypass PD patient is a woman in the sixth decade of life, presenting most commonly with pain (69.2%) and/or jaundice (53.8%), median 5 years after RYGB. Five post-PD reconstructive options are reported. Among these, the gastric remnant was resected in 18 cases (69.2%), with reconstruction of biliopancreatic drainage most commonly achieved using the distal jejunal segment of the pre-existing biliopancreatic limb (73.1%). Similarly, in the eight cases where the gastric remnant was spared (30.8%), drainage was most commonly performed using the distal jejunal segment of the biliopancreatic limb (50%). Among the 17 cases reporting follow-up data, median was 27 months.ConclusionReconstruction options after PD in the post-RYGB patient focus on resection or preservation gastric remnant, as well as creation of new biliopancreatic limb. Insufficient data exists to make recommendations regarding the optimal reconstruction option, yet surgeons must prepare for the possible clinical challenge. PD reconstruction post-RYGB requires evaluation through prospective studies.

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Pancreaticoduodenectomy in Patients with Previous Roux-en-Y Gastric Bypass: a Matched Case-Control Study

Tsamalaidze

Asbun

Costa³

et al. 2019

OBES SURG

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A Novel Reconstruction Technique During Pancreaticoduodenectomy After Roux-En-Y Gastric Bypass: How I do It

Cited by 3 publications

References 24 publications

Pancreaticoduodenectomy after Roux-en-Y Gastric Bypass: a novel reconstruction technique

Pancreaticoduodenectomy after Roux-en-Y Gastric Bypass: a novel reconstruction technique

Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review

Pancreaticoduodenectomy in Patients with Previous Roux-en-Y Gastric Bypass: a Matched Case-Control Study

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