Pancreaticoduodenectomy following gastrectomy reconstructed with Billroth II or Roux-en-Y method: Case series and literature review. (2017)

• Record Type: Journal Article
• Authors: Kawamoto, Yusuke; Ome, Yusuke; Kouda, Yusuke; Saga, Kennichi; Park, Taebum; Kawamoto, Kazuyuki
• Is Part Of: International journal of surgery case reports. Volume 35(2017)
• Page Start: 106
• Page End: 109
• Publication Date: 2017
• Subjects: Pancreaticoduodenectomy following gastrectomy -- Roux-en-Y -- Billroth II -- Afferent loop syndrome; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.04.018
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: The ideal reconstruction method for pancreaticoduodenectomy following a gastrectomy with Billroth II or Roux-en-Y is proposed. Half patients in whom the past afferent limb was used for the reconstruction of the pancreaticojejunostomy and hepaticojejunostomy experienced afferent loop syndrome. The Roux-en-Y method, using the distal intestine of previous gastrojejunostomy or jejunojejunostomy as a new jejunal limb for pancreaticojejunostomy and hepaticojejunostomy, may be a better reconstruction method to avoid afferent loop syndrome. Abstract: Introduction: The ideal reconstruction method for pancreaticoduodenectomy following a gastrectomy with Billroth II or Roux-en-Y reconstruction is unclear. Methods: We reviewed a series of seven pancreaticoduodenectomies performed after gastrectomy with the Billroth II or Roux-en-Y method. Results: While preserving the existing gastrojejunostomy or esophagojejunostomy, pancreaticojejunostomy and hepaticojejunostomy were performed by the Roux-en-Y method using a new Roux limb in all cases. Four patients experienced postoperative complications, although the specific complications varied. Discussion: A review of the literature revealed 13 cases of pancreaticoduodenectomy following gastrectomy with Billroth II or Roux-en-Y reconstruction. Three patients out of six (50%) in whom the past afferent limb was used for the reconstruction of the pancreaticojejunostomy and hepaticojejunostomy experienced afferent loop syndrome, while 14 previous and current patients in whom a new jejeunal limb was used did not experience this complication. Conclusion: The Roux-en-Y method, using the distal intestine of previous gastrojejunostomy or jejunojejunostomy as a new jejunal limb for pancreaticojejunostomy and hepaticojejunostomy, may be a better reconstruction method to avoid the complication of afferent loop syndrome after previous gastrectomy with Billroth II or Roux-en-Y reconstruction if the afferent limb is less than 40 cm.