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, 24 (1), 76-87

Pancreatic Head Resection Following Roux-en-Y Gastric Bypass: Operative Considerations and Outcomes

Collaborators, Affiliations

Pancreatic Head Resection Following Roux-en-Y Gastric Bypass: Operative Considerations and Outcomes

M T Trudeau et al. J Gastrointest Surg.

Abstract

Purpose: This study aimed to identify optimal management decisions for surgeons preforming pancreatic head resection on patients with altered anatomy due to a previous Roux-en-Y gastric bypass (RYGB).

Methods: A multi-national (4), multi-center (28) collaborative of 55 pancreatic surgeons who have performed pancreatoduodenectomy or total pancreatectomy following RYGB for obesity (2005-2018) was created. Demographics, operative details, and perioperative outcomes from this cohort were analyzed and compared in a propensity-score matched analysis with a multi-center cohort of 5533 pancreatoduodenectomies without prior RYGB.

Results: Ninety-six patients with a previous RYGB undergoing pancreatic head resection were assembled. Pathologic indications between the RYGB and normal anatomy cohorts did not differ. Propensity score matching of RYGB vs. patients with unaltered anatomy demonstrated no differences in major postoperative outcomes. In total 20 distinct reconstructions were employed (of 37 potential options); the three most frequent reconstructions accounted for 52.1%, and none demonstrated superior outcomes. There were no differences in outcomes observed between original biliopancreatic limb use (66.7%) and those where a secondary Roux limb was created for biliopancreatic reconstruction. Remnant stomachs were removed in 54.7% of cases, with no outcome differences between resected and retained stomachs. Venting gastrostomy tubes were used in 36.2% of retained stomachs without obvious outcome benefits. Jejunostomy tubes were used infrequently (11.7%).

Conclusions: Pancreatic head resection after RYGB is an infrequently encountered, unique and challenging scenario for any given surgeon. These patients do not appear to suffer higher morbidity than those with unaltered anatomy. Various technical reconstructive options do not appear to confer distinct benefits.

Keywords: Bariatric surgery; Gastric bypass; Obesity; Pancreatoduodenectomy; Roux-en-Y; Whipple.

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References

    1. Surg Endosc. 2013 Apr;27(4):1273-80 - PubMed

References

    1. Gastrointest Endosc Clin N Am. 2011 Apr;21(2):305-13 - PubMed

References

    1. World J Surg Oncol. 2018 Aug 13;16(1):168 - PubMed

References

    1. J Am Coll Surg. 2011 Aug;213(2):261-6 - PubMed

References

    1. Surg Obes Relat Dis. 2015 Mar-Apr;11(2):313-20 - PubMed

References

    1. HPB (Oxford). 2018 Jan;20(1):34-40 - PubMed

References

    1. Endoscopy. 2014 Jul;46(7):560-72 - PubMed

References

    1. Abdom Imaging. 2015 Oct;40(8):2921-31 - PubMed

References

    1. Surgery. 2017 Mar;161(3):584-591 - PubMed

References

    1. Horm Mol Biol Clin Investig. 2015 May;22(2):39-51 - PubMed

References

    1. J Am Coll Surg. 2010 Mar;210(3):286-98 - PubMed

References

    1. Surgery. 2007 Nov;142(5):761-8 - PubMed

References

    1. Clin Gastroenterol Hepatol. 2014 Oct;12(10):1635-44.e5; quiz e103 - PubMed

References

    1. N Engl J Med. 2017 Feb 16;376(7):641-651 - PubMed

References

    1. Gastrointest Endosc. 2012 Apr;75(4):748-56 - PubMed

References

    1. Semin Ultrasound CT MR. 2013 Aug;34(4):311-24 - PubMed

References

    1. Endosc Int Open. 2015 Oct;3(5):E458-63 - PubMed

References

    1. Clin Cancer Res. 2015 Aug 1;21(15):3522-8 - PubMed

References

    1. J Gastrointest Surg. 2014 Apr;18(4):869-77 - PubMed

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