Acute afferent loop syndrome in the early postoperative period following pancreaticoduodenectomy.
BACKGROUND
Afferent loop syndrome (ALS) is a recognised complication of foregut surgery caused by mechanical obstruction at the gastrojejunostomy anastomosis itself or at a point nearby. Acute ALS has only been reported following pancreaticoduodenectomy (PD) after several years due to recurrence of malignancy at the anastomotic site. We report five cases of acute ALS in the first postoperative week.


METHODS
The presentation, clinical findings and successful management of the 5 patients with ALS were obtained from a prospectively collected database of 300 PDs. All five patients with early acute ALS presented with signs and symptoms of a bile leak. Since the fifth patient, the surgical technique has been modified with the creation of a larger window in the transverse mesocolon and a Braun enteroenterostomy.


RESULTS
There have been no further incidents of ALS since the adoption of these modifications to the standard technique of PD and there has also been a reduction in postoperative bile leaks (6.4% vs 3.6%, p=0.416).


CONCLUSIONS
Acute ALS is a rare but important complication in the immediate postoperative period following PD and causes disruption to adjacent anastomoses, resulting in a bile leak. A prophylactic Braun anastomosis and wide mesocolic window may prevent this complication and subsequent deterioration.
Royal Surrey County Hospital NHS Foundation Trust , UK.
H
H
Nageswaran
Royal Surrey County Hospital NHS Foundation Trust , UK.
A
A
Belgaumkar
Royal Surrey County Hospital NHS Foundation Trust , UK.
R
R
Kumar
Royal Surrey County Hospital NHS Foundation Trust , UK.
A
A
Riga
Royal Surrey County Hospital NHS Foundation Trust , UK.
N
N
Menezes
Royal Surrey County Hospital NHS Foundation Trust , UK.
T
T
Worthington
Royal Surrey County Hospital NHS Foundation Trust , UK.
N D
ND
Karanjia
D000328:Adult; D000343:Afferent Loop Syndrome / Q000209:etiology*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies
Afferent loop syndrome; Braun anastomosis; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative complications; Roux-en-Y anastomosis