title: Pancreaticoduodenectomy in patients with a history of Roux-en Y gastric bypass surgery.
abstract: BACKGROUND
  Roux-en Y gastric bypass surgery is the most common operation for treatment of morbid obesity. The approach to pancreaticoduodenal resection in patients with a history of Roux-en Y gastric bypass is not well described.
  
  
  METHODS
  Pancreaticoduodenal resection was performed in two patients with distal bile duct strictures, with a past history of Roux-en Y gastric bypass. In both cases the remnant stomach, distal bile duct, duodenum and pancreas were excised. The biliopancreatic limb was divided close to the ligament of Treitz and brought up into the supracolic compartment in a retromesenteric manner and pancreatic and biliary anastomoses performed. The previous enteroenterostomy and gastrojejunal anastomoses were left intact. Both patients had an uncompleted post-operative recovery. The mean operating time was 6.5 hours and mean estimated blood loss was 525 mL. They were discharged home by days 6 and 7 post-operatively.
  
  
  CONCLUSIONS
  Pancreaticoduodenal resection can be successfully performed following Roux-en Y gastric bypass with en-bloc excision of the remnant stomach, with the pancreas and bile duct anastomosed to the divided biliopancreatic limb.
authors.affiliation: Department of Surgery, University Hospitals, Case Medical Center, Cleveland, OH, USA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Staveley-O'Carroll
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Hardacre
mesh_terms: D000368:Aged; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome