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. 2017:35:106-109.
doi: 10.1016/j.ijscr.2017.04.018. Epub 2017 Apr 18.

Pancreaticoduodenectomy following gastrectomy reconstructed with Billroth II or Roux-en-Y method: Case series and literature review

Yusuke Kawamoto  1 , Yusuke Ome  2 , Yusuke Kouda  3 , Kennichi Saga  4 , Taebum Park  5 , Kazuyuki Kawamoto  6
Affiliations

Pancreaticoduodenectomy following gastrectomy reconstructed with Billroth II or Roux-en-Y method: Case series and literature review

Yusuke Kawamoto et al. Int J Surg Case Rep. 2017.

Abstract

Introduction: The ideal reconstruction method for pancreaticoduodenectomy following a gastrectomy with Billroth II or Roux-en-Y reconstruction is unclear.

Methods: We reviewed a series of seven pancreaticoduodenectomies performed after gastrectomy with the Billroth II or Roux-en-Y method.

Results: While preserving the existing gastrojejunostomy or esophagojejunostomy, pancreaticojejunostomy and hepaticojejunostomy were performed by the Roux-en-Y method using a new Roux limb in all cases. Four patients experienced postoperative complications, although the specific complications varied.

Discussion: A review of the literature revealed 13 cases of pancreaticoduodenectomy following gastrectomy with Billroth II or Roux-en-Y reconstruction. Three patients out of six (50%) in whom the past afferent limb was used for the reconstruction of the pancreaticojejunostomy and hepaticojejunostomy experienced afferent loop syndrome, while 14 previous and current patients in whom a new jejeunal limb was used did not experience this complication.

Conclusion: The Roux-en-Y method, using the distal intestine of previous gastrojejunostomy or jejunojejunostomy as a new jejunal limb for pancreaticojejunostomy and hepaticojejunostomy, may be a better reconstruction method to avoid the complication of afferent loop syndrome after previous gastrectomy with Billroth II or Roux-en-Y reconstruction if the afferent limb is less than 40cm.

Keywords: Afferent loop syndrome; Billroth II; Pancreaticoduodenectomy following gastrectomy; Roux-en-Y.

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Figures

Fig. 1
Fig. 1
Reconstruction of pancreaticoduodenectomy following gastrectomy with a Billroth II or a Roux-en-Y. While preserving the existing gastrojejunostomy or esophagojejunostomy, we used a new Roux limb for pancreaticojejunostomy and cholangiojejunostomy.(For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.) Red arrow: previous Roux limb.
Fig. 2
Fig. 2
An example of reconstruction of pancreaticoduodenectomy using the past afferent limb for pancreatic and biliary reconstruction. a: the length of the afferent limb.
See this image and copyright information in PMC

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