June S Peng1, Ricard Corcelles1, Kevin Choong2, Matthew Poturalski3, Namita Gandhi3, R Matthew Walsh1, Jeffrey M Hardacre2, Stacy A Brethauer1, Gareth Morris-Stiff4. 1. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland OH, USA. 2. Department of General Surgery, University Hospitals, Cleveland OH, USA. 3. Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic Foundation, Cleveland OH, USA. 4. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland OH, USA. Electronic address: morrisg4@ccf.org.
Abstract
BACKGROUND: Patients with altered anatomy due to Roux-en-Y gastric bypass (RYGB) present unique diagnostic and therapeutic challenges when they present with periampullary pathology. We describe a series of patients who underwent pancreatoduodenectomy (PD) after gastric surgery with Roux-en-Y reconstruction and review the literature to highlight technical considerations and outcomes. METHODS: Patients from two institutions were identified and data regarding preoperative workup, operative conduct, and pathologic and clinical outcomes were collected. RESULTS: Eleven patients were included in the institutional series. At the time of periampullary pathology, the median age was 64 years and time since RYGB was 10 years. Median operative time was 361 minutes, estimated blood loss was 500 mLs, and length of stay was 6 days. Remnant gastrectomy was performed in nine patients and reconstruction was performed using the biliopancreatic limb (BP) without revision of the jejuno-jejunostomy in ten patients. Pathology revealed pancreatic cancer (8), chronic pancreatitis (2), and duodenal cancer (1). Three patients experienced major complications and there were no 90-day mortalities. CONCLUSION: Pancreatic surgeons will see an increasing number of patients with Roux-en-Y anatomy who will require evaluation and resection for periampullary diseases. For PD after RYGB, we recommend remnant gastrectomy with reconstruction using the BP limb.
BACKGROUND:Patients with altered anatomy due to Roux-en-Y gastric bypass (RYGB) present unique diagnostic and therapeutic challenges when they present with periampullary pathology. We describe a series of patients who underwent pancreatoduodenectomy (PD) after gastric surgery with Roux-en-Y reconstruction and review the literature to highlight technical considerations and outcomes. METHODS:Patients from two institutions were identified and data regarding preoperative workup, operative conduct, and pathologic and clinical outcomes were collected. RESULTS: Eleven patients were included in the institutional series. At the time of periampullary pathology, the median age was 64 years and time since RYGB was 10 years. Median operative time was 361 minutes, estimated blood loss was 500 mLs, and length of stay was 6 days. Remnant gastrectomy was performed in nine patients and reconstruction was performed using the biliopancreatic limb (BP) without revision of the jejuno-jejunostomy in ten patients. Pathology revealed pancreatic cancer (8), chronic pancreatitis (2), and duodenal cancer (1). Three patients experienced major complications and there were no 90-day mortalities. CONCLUSION: Pancreatic surgeons will see an increasing number of patients with Roux-en-Y anatomy who will require evaluation and resection for periampullary diseases. For PD after RYGB, we recommend remnant gastrectomy with reconstruction using the BP limb.
Authors: Levan Tsamalaidze; Horacio J Asbun; Roland Montenegro Costa; Luciano D Olival; John A Stauffer Journal: Obes Surg Date: 2020-01 Impact factor: 4.129
Authors: William F Morano; Mohammad F Shaikh; Elizabeth M Gleeson; Alvaro Galvez; Marian Khalili; John Lieb; Elizabeth P Renza-Stingone; Wilbur B Bowne Journal: World J Surg Oncol Date: 2018-08-13 Impact factor: 2.754