Ann Surg Treat Res.  2022 Jun;102(6):323-327. 10.4174/astr.2022.102.6.323.

Various types of reconstruction after pancreaticoduodenectomy for the patients who underwent all types of gastrectomy: a single-center experience

• Jeon HJ
• Kwon HJ
• Hwang YJ
• Kim SG

• KMID: 2530386
• DOI: http://doi.org/10.4174/astr.2022.102.6.323

Abstract

Purpose
The incidence of patients requiring pancreaticoduodenectomy (PD) following any type of gastrectomy is increasing as the population of elderly patients is increasing, especially in endemic areas of gastric cancer such as Korea. All types of gastrectomy can be categorized as subtotal gastrectomy with Billroth I (BI), Billroth II (BII), and total gastrectomy with Roux-en-Y anastomosis. In this paper, we reviewed our experiences of PD for patients who previously underwent gastrectomy.
Methods
We reviewed the medical records of the patients who underwent PD following any type of gastrectomy among 505 consecutive patients who underwent PD in a single institution between 2011 and 2020 retrospectively.
Results
There were 13 patients who had undergone gastrectomy including 7 patients of BI, 1 patient of BII, and 5 patients of total gastrectomy. For all 7 patients of BI, the reconstruction was not different from conventional PD. For the 1 patient of BII, previous gastrojejunal anastomosis was preserved and reconstruction was performed in Roux-en-Y method. For the 5 patients with total gastrectomy, 2 different types of reconstruction were performed. In one patient, we removed the remaining jejunum with the specimen, and reconstruction was performed. For the other 4 patients, the remaining jejunum, distal to the Treitz ligament, was preserved and was utilized for anastomosis. Surgeries for all patients were uneventful.
Conclusion
PD following any type of gastrectomy can be safe. Especially, if the length of remained jejunum is long enough, its utilization for the reconstruction can be an appropriate option.

Keyword

Gastrectomy; Pancreaticoduodenectomy; Second primary neoplasms

Figure

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  Fig. 1 Reconstruction of pancreaticoduodenectomy (PD) following subtotal gastrectomy with a Billroth I. The surgery was not different from conventional PD.

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  Fig. 2 Reconstruction of pancreaticoduodenectomy following subtotal gastrectomy with a Billroth II. Previous gastrojejunal anastomosis was preserved.

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  Fig. 3 Reconstruction of pancreaticoduodenectomy following total gastrectomy with Roux-en-Y method. We removed the remained jejunum distal to Treitz ligament with the specimen and new reconstruction was performed in Roux-en-Y method.

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  Fig. 4 Reconstruction of pancreaticoduodenectomy following total gastrectomy with Roux-en-Y method. The remained jejunum distal to Treitz ligament was preserved and it was utilized for the pancreaticojejunostomy and hepaticojejunostomy.

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