title: Is Revision Surgery Justified for Symptomatic Pancreatico-enteric Anastomotic Stenosis in Long-term Survivors Following Pancreaticoduodenectomy for Malignancy?
abstract: Pancreatico-enteric anastomotic (PEA) stenosis is one of the late complications following pancreaticoduodenectomy (PD) and reported for benign diseases. Literature for PEA stenosis following PD for malignancy is very limited due to low survival.
  
  
  
  Patients undergoing surgery for symptomatic, recurrent, obstructive pancreatitis due to PEA stenosis following PD for malignancy were retrospectively identified from the authors' prospective database between January 1997 and December 2014.
  
  
  
  Six patients with median age 56.5 years underwent revision surgery for PEA stenosis during this time period. At primary PD, all were node negative with T1/T2 disease. The primary PEA were pancreatico-jejunostomy (PJ) (n = 5) and pancreatico-gastrostomy (n = 1). Median time to develop symptoms was 62 months. At revision surgery, a Roux-en-Y longitudinal PJ (n = 5) and an end-to-side PJ (n = 1) were done. With a median follow-up of 36 months, pain relief was excellent (n = 5) to average (n = 1).
  
  
  
  With improving long-term survival in patients undergoing PD for malignancy more such patients will be identified in future. Patients with symptomatic PEA stenosis following PD for malignancy can be managed surgically, with excellent outcomes in centers of expertise in pancreatic surgery.
authors: Department of Gastrointestinal Services, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India. drprasadwagle@gmail.com.
authors: Prasad
authors: P
authors: Wagle
authors: Department of Gastrointestinal Services, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
authors: Kamal Sunder
authors: KS
authors: Yadav
authors: Department of Gastrointestinal Services, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
authors: Priyanka Akhilesh
authors: PA
authors: Sali
authors: Department of Gastrointestinal Services, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
authors: Raman
authors: R
authors: Garg
authors: Department of Gastrointestinal Services, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
authors: Paresh
authors: P
authors: Varty
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D050500:Pancreatitis, Chronic / Q000209:etiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017741:Survivors
keywords: Pancreatico-enteric stenosis; Pancreaticoduodenectomy; Pancreatitis; Whipple’s procedure