Pancreaticoduodenectomy performed in patients with a history of multiple biliary tract operations

Abstract

Objective To summarize the surgical technique and experience of pancreaticoduodenectomy for patients with medical history of multiple biliary tract surgery. Methods Four patients who had undergone multiple biliary tract surgeries received pancreaticoduodenectomy in China-Japan friendship hospital, including 2 male and 2 female patients, with the age of 17-73 years old. Two cases underwent pancreaticoduodenectomy for residual cyst canceration after repeated surgery for congenital bile duct cyst. One case was found with malignant obstruction by choledochoscope after multiple biliary tract surgery, left hemihepatectomy and T-tube drainage due to intra- and extra-hepatic cholelithiasis. The other case underwent pancreaticoduodenectomy because of cancer recurrence on region of the pancreatic head, who had had a hiatory of repeated surgery for acute cholecystitis and gallbladder cancer. Results Pancreaticoduodenectomy for all these four patients were successfully completed. Among them, one case received pancreaticoduodenectomy combined with hepatic artery resection and anastomosis. Gastric paralysis ensued in one case, abdominal cavity infection in one case, and biliary fistula in one case, respectively. One case died of cancer recurrence 15 months later. The other 3 cases were still alive in the follow-up of 4 to 42 months. Conclusion Pancreaticoduodenectomy can be safely performed for patients who had received multiple biliary tract surgeries. It is crucial that the Cattell and Braasch maneuver was taken from right to left and bottom up ways. It is better to keep the unobstructed bile intestinal anastomosis in place hence reduce serious complications. Key words: Reoperation; Pancreaticoduodenectomy; Biliary tract surgery