Pancreaticoduodenectomy after a Roux-en-Y gastric bypass.
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.
Khithani
Amit S
AS
Methodist Dallas Medical Center, Dallas, TX, USA.
Curtis
David E
DE
Galanopoulos
Christos
C
Jeyarajah
Dhiresh Rohan
DR
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