title: Pancreaticojejuno-jejunostomy during reconstruction of the afferent loop in surgery of radiation-induced afferent loop obstruction following pancreaticoduodenectomy with Roux-en-Y reconstruction.
abstract: Radiation-induced afferent loop obstruction is a rare complication following pancreaticoduodenectomy and adjuvant radiotherapy. As in the setting of Roux-en-Y reconstruction endoscopic approaches are limited, surgery of this complication becomes inevitable. This study provides a new classification/management system of the radiation-induced obstruction of the afferent loop based on the extent and location of radiation injury, and describes the Pancreaticojejuno-jejunostomy, a novel technique to avoid revision of the pancreatic anastomosis during reconstruction of the afferent loop. Data were analyzed from nine patients who developed radiation-induced afferent loop obstruction after pancreaticoduodenectomy with single Roux limb reconstruction. One patient had type I obstruction and treated with by-pass surgery, seven patients had type II obstruction and treated with reconstruction including revision of the hepaticojejunostomy and Pancreaticojejuno-jejunostomy, and one patient had type III obstruction and treated with reconstruction including revision of the hepaticojejunostomy and the pancreatic anastomosis. Reconstruction along with Pancreaticojejuno-jejunostomy performed in six patients with type II radiation-induced afferent loop obstruction; reconstruction was not feasible for one patient. The median operative time was 149 min. No intraoperative complication was observed. By performing Pancreaticojejuno-jejunostomy we managed efficiently to convert a pancreatic anastomosis to an enteric anastomosis as one case of Grade B pancreatic fistula and no case of Pancreaticojejuno-jejunostomy stricture were observed, regarding short- and long-term results, respectively. The above technique may have a useful application in the surgical management of the radiation-induced afferent loop obstruction when endoscopy fails and by-pass surgery is inappropriate.
authors.affiliation: Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100, Drama, Greece, kostasblu@hotmail.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Blouhos
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Boulas
authors.forename: Evridiki
authors.initials: E
authors.lastname: Tsiomita
authors.forename: Irene
authors.initials: I
authors.lastname: Papageorgiou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ioannidis
authors.forename: Anestis
authors.initials: A
authors.lastname: Hatzigeorgiadis
mesh_terms: D000343:Afferent Loop Syndrome / Q000209:etiology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011832:Radiation Injuries / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*