Pancreaticoduodenectomy after Roux-en-Y gastric bypass: A single institution retrospective case series

Abstract

Introduction:The unique challenges of pancreaticoduodenectomy in a patient with altered midgut anatomy secondary to RouxenY gastric bypass are seldom discussed in surgical literature. We discuss two such cases at our institution, in light of experiences of other authors. Case Series: The two cases reported here are different from the majority of previously reported cases as remnant gastrectomy was not performed in either patient. However, one patient did receive a gastrostomy tube in the gastric remnant. The essential differences in existing literature are the removal of the gastric remnant in other reports versus a gastrojejunal anastomosis for remnant drainage in our cases, without any clear advantage in either case. Gastric remnant dissection increases operative time in contrast to gastrojejunal anastomosis, which is a nidus for complications postoperatively. With preservation of gastric remnant however, enteral feeding tube can be placed without manipulation of the altered anatomy, as the need arises. Conculsion: Gastric remnant removal is ideal in decreasing the complexity of pancreaticoduodenectomy by reducing the number of required anastomoses. However, there is an increase in operative time required for dissection of the remnant gastric pouch.

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

“…In the included articles, 25 patient cases were reported; our institution included an additional case, for a total of 26 cases (Fig. 1 ) [ 13 – 20 ]. Table 1 contains a synopsis of all reported cases with regard to clinicopathological characteristics.…”

“…Procedures included pancreaticoduodenectomy [ 21 ], pylorus-preserving pancreaticoduodenectomy [ 1 ], and total pancreatectomy [ 1 ]. Report of resection margin status [ 13 ] and histologic lymph node examination [ 4 ] for malignancies were infrequently provided. The gastric remnant was resected in majority of patients [ 18 ].…”

Pancreatoduodenectomy after Roux-en-Y gastric bypass: technical considerations and outcomes

“…Articles cited within the initially identified batch were also screened and a total of seven cases and series were identified for inclusion. [5][6][7][8][9][10][11]…”

“…Literature review A literature search revealed seven publications describing a total of 14 patients. [5][6][7][8][9][10][11] The preoperative workup, operative management of the remnant stomach and reconstruction, and postoperative complications are summarized in Table 4. The indications for surgery were variable and included both benign and malignant processes.…”

“…Of the reported cases in the literature, 10 of 14 patients underwent reconstruction using the BP limb. [6][7][8][9]11 The advantage of using a bypassed BP limb includes placing the PJ and HJ in a defunctionalized part of the anatomy, which makes enteral nutrition possible even when there is a biliary or pancreatic leak.…”