Pancreaticoduodenectomy in patients with Roux-en-Y gastric bypass: a matched case-control study

Abstract

Background: Pancreaticoduodenectomy (PD) is routine for pancreatic head pathology but little is known regarding outcomes of PD in patients with previous Roux-en-Y gastric bypass (RYGB). The aim of this study was to review our experience with PD after RYGB. Methods: A retrospective case-control study of patients undergoing PD after RYGB from 01/2012 to 07/2017 was performed. Patients with RYGB were matched by age, sex, operative approach, pathology, and year of surgery to non-RYGB patients undergoing PD. Demographic and operative outcomes were reviewed and compared. Results: Of 309 patients undergoing PD, 9 (2.9%) had previous RYGB. Mean time between RYGB and PD was 142.8 months. Three patients (33.3%) required percutaneous transhepatic cholangiography (PTC) with subsequent stent placement in two patients (22.2%). Laparoscopic and open approaches were utilized in one and nine patients respectively. The remnant stomach was excised in 5 patients and from remaining four cases; transgastric jejunal feeding tube was placed in two patients. Nine patients with RYGB were matched to 27 non-RYGB (1:3) patients. No differences were found between groups in mean operative time, length of hospital stay or postoperative morbidity (Table 1). More patients with RYGB required PTC and stent placement due to altered anatomy than non-RYGB ones, but this difference did not reach significance. No significant difference was revealed in the time interval between time of diagnosis in asymptomatic patients or date of the first symptoms in symptomatic patients and the date of surgery between comparison groups. No 90-day mortality was noted in the study groups. Conclusion: Past surgical history of RYGB in patients with pancreatic head pathology does not result in delay in PD. PD has comparable outcomes in patients with previous RYGB to those in non-RYGB patients.Tabled 1CharacteristicWith RYGB (n=9)Without RYGB (n=27)P valueAge, y62.1 (7.0)63.8 (7.0)0.53BMI, kg/m229.4 (6.5)27.0 (6.2)0.32Female9(100.0)27 (100.0)>0.99Hypertension9 (100.0)17 (63.0)0.04Cardiac disease4 (44.4)6 (22.2)0.65Diabetes mellitus4 (44.4)5 (18.5)0.18History of pancreatitis2 (22.2)1 (3.7)0.14Previous upper abd. surgeries9 (100.0)3 (11.1)<0.001Asymptomatic1 (11.1)5 (18.5)>0.99Jaundice3 (33.3)8 (29.6)>0.99Time after RYGB, mo142.8 (106.8)……PTC3 (33.3)2 (7.4)0.08PTC with stentplacement2 (22.2)0 (0.0)0.06Diagnosis-Surgery, mo7.3 (5.9)9.3 (18.6)0.75ASA class II0 (0.0)0 (0.0)… III8 (88.9)27 (100.0)0.25 IV1 (11.1)0 (0.0)0.25Resection type Laparoscopic1 (11.1)3 (11.1)>0.99 Open8 (88.9)24 (88.9)>0.99Excision of the RS5 (55.5)……TG jejunal FT2 (22.2)……Operative time, min295.0 (92.6)313.9 (118.6)0.66EBL, ml341.7 (259.8)353.3(454.4)0.94LOS, d6.4 (5.2)6.6 (2.5)0.8790-Day morbidity Minor (CI grade I-II)2 (22.2)8 (29.6)>0.99 Major (CI grade III-V)3 (33.3)9 (24.3)>0.99 CR-DGE0 (0.0)2 (7.4)>0.99 CR-POPF1 (11.1)3 (11.1)>0.99Death0 (0.0)0 (0.0)…Follow-up, mo14.4 (13.2)20.2 (16.1)0.33 Open table in a new tab