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.