title: Pancreaticoduodenectomy after a Roux-en-Y gastric bypass.
abstract: BACKGROUND
  The surgical management of periampullary lesions, status post-Roux-en-Y gastric bypass procedure (RYGBP), poses a challenge. The strategy should focus on managing the gastric remnant.
  
  
  METHODS
  We propose a technique of managing the gastric remnant while doing a pancreaticoduodenectomy (PD) in a patient with a previous RYGBP. From September 2005 to June 2008, two patients with a previous RYGBP underwent PD with a modified technique. The records were reviewed with respect to preoperative, intraoperative, and postoperative data.
  
  
  RESULTS
  Both patients were operated for a carcinoma of the head of pancreas. Neither patient underwent a preoperative endoscopic ultrasound. The operating times were 315 and 218 min. There was no mortality or morbidity seen. Neither patient was re-operated. The mean length of stay was 6 days.
  
  
  CONCLUSIONS
  The technique suggests an approach of managing the gastric remnant and preventing delayed gastric emptying which resulted in a decreased length of hospital stay.
authors.affiliation: Methodist Dallas Medical Center, Dallas, TX, USA.
authors.forename: Amit S
authors.initials: AS
authors.lastname: Khithani
authors.forename: David E
authors.initials: DE
authors.lastname: Curtis
authors.forename: Christos
authors.initials: C
authors.lastname: Galanopoulos
authors.forename: Dhiresh Rohan
authors.initials: DR
authors.lastname: Jeyarajah
mesh_terms: D002277:Carcinoma / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D018530:Gastric Stump; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome