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Case Series
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| Pancreaticoduodenectomy after Roux-en-Y gastric bypass: A single institution retrospective case series | ||||||
| Ryan Helmick1, Ranjodh Singh3, Jeffery Welshhans2, Elliot J Fegelman2, Hassan Shahid4 | ||||||
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1MD, Resident Physician 5th year, Department of Surgery, The Jewish Hospital, Cincinnati, OH, United States.
2MD, Attending Surgeon, Department of Surgery, The Jewish Hospital, Cincinnati, OH, United States. 3MD, Resident Physician 4th year, Department of Surgery, The Jewish Hospital, Cincinnati, OH, United States. 4Medical Student 3rd year, Department of Surgery, The Jewish Hospital, Cincinnati, OH, United States. | ||||||
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| How to cite this article: |
| Helmick R, Singh R, Welshhans J, Fegelman EJ, Shahid H. Pancreaticoduodenectomy after Roux-en-Y gastric bypass: A single institution retrospective case series. International Journal of Hepatobiliary and Pancreatic Diseases 2013;3:17–20. |
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Abstract
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Introduction:
The unique challenges of pancreaticoduodenectomy in a patient with altered midgut anatomy secondary to Roux-en-Y 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. Conclusion: 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. | |
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Keywords:
Gastric bypass, Gastric remnant, Pancreaticoduodenectomy
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Author Contributions:
Ryan Helmick – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Ranjodh Singh – Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Jeffery Welshhans – Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Elliot J Fegelman – Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Hassan Shahid – Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Ryan Helmick et al. 2013 This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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