INTRODUCTION: Afferent loop syndrome (ALS) is a recognised complication of foregut surgery caused by mechanical obstruction at the gastrojejunostomy anastomosis itself or at a point nearby. Acute ALS has only been reported following pancreaticoduodenectomy (PD) after several years due to recurrence of malignancy at the anastomotic site. We report five cases of acute ALS in the first postoperative week. METHODS: The presentation, clinical findings and successful management of the 5 patients with ALS were obtained from a prospectively collected database of 300 PDs. All five patients with early acute ALS presented with signs and symptoms of a bile leak. Since the fifth patient, the surgical technique has been modified with the creation of a larger window in the transverse mesocolon and a Braun enteroenterostomy. RESULTS: There have been no further incidents of ALS since the adoption of these modifications to the standard technique of PD and there has also been a reduction in postoperative bile leaks (6.4% vs 3.6%, p=0.416). CONCLUSIONS: Acute ALS is a rare but important complication in the immediate postoperative period following PD and causes disruption to adjacent anastomoses, resulting in a bile leak. A prophylactic Braun anastomosis and wide mesocolic window may prevent this complication and subsequent deterioration.
INTRODUCTION: Afferent loop syndrome (ALS) is a recognised complication of foregut surgery caused by mechanical obstruction at the gastrojejunostomy anastomosis itself or at a point nearby. Acute ALS has only been reported following pancreaticoduodenectomy (PD) after several years due to recurrence of malignancy at the anastomotic site. We report five cases of acute ALS in the first postoperative week. METHODS: The presentation, clinical findings and successful management of the 5 patients with ALS were obtained from a prospectively collected database of 300 PDs. All five patients with early acute ALS presented with signs and symptoms of a bile leak. Since the fifth patient, the surgical technique has been modified with the creation of a larger window in the transverse mesocolon and a Braun enteroenterostomy. RESULTS: There have been no further incidents of ALS since the adoption of these modifications to the standard technique of PD and there has also been a reduction in postoperative bile leaks (6.4% vs 3.6%, p=0.416). CONCLUSIONS: Acute ALS is a rare but important complication in the immediate postoperative period following PD and causes disruption to adjacent anastomoses, resulting in a bile leak. A prophylactic Braun anastomosis and wide mesocolic window may prevent this complication and subsequent deterioration.
Authors: Richard A Burkhart; Daniel Relles; Danielle M Pineda; Salil Gabale; Patricia K Sauter; Ernest L Rosato; Leonidas G Koniaris; Harish Lavu; Eugene P Kennedy; Charles J Yeo; Jordan M Winter Journal: J Gastrointest Surg Date: 2013-01-05 Impact factor: 3.452
Authors: Rahul Pannala; John J Brandabur; Seng-Ian Gan; Michael Gluck; Shayan Irani; David J Patterson; Andrew S Ross; Russell Dorer; L William Traverso; Vincent J Picozzi; Richard A Kozarek Journal: Gastrointest Endosc Date: 2011-08 Impact factor: 9.427
Authors: Adriana C Gamboa; Mohammad Y Zaidi; Rachel M Lee; Juan M Sarmiento; David A Kooby; Maria C Russell; Kenneth Cardona; Shishir K Maithel Journal: J Gastrointest Surg Date: 2019-08-29 Impact factor: 3.452