Ann Hepatobiliary Pancreat Surg.  2023 Aug;27(3):317-321. 10.14701/ahbps.22-137.

Pancreatoduodenectomy with uncut-Roux-en-Y reconstruction in patients with previous radical gastrectomy

• Kim HJ
• Shin HS
• Park SH
• Yang HY
• Kang CM

• KMID: 2545780
• DOI: http://doi.org/10.14701/ahbps.22-137

Abstract

Gastric cancer is very common. Many patients have undergone radical gastric cancer surgery in Korea. Recently, the number of cases with secondary cancer occurring in other organs such as periampullary cancers is increasing as survival rate of gastric cancer patients increases. There are some clinical issues in managing patients with periampullary cancer who have undergone radical gastrectomy previously. Considering that pancreatoduodectomy (PD) has two phases (i.e., resection and reconstruction), it can be very complicated and controversial to perform safe and effective reconstruction following PD in patients with a previous radical gastrectomy. In this report, we present our experiences of uncut-Roux-en-Y fashioned reconstruction in PD for patients with a previous radical gastrectomy and discuss its technical characteristics and potential advantages.

Keyword

Pancreatoduodenectomy; Radical gastrectomy; Periampullary cancer; Uncut Roux-en-Y

Figure

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  Fig. 1 Uncut-Roux-en-Y reconstruction after pancreatoduodenectomy (PD) in patients with radical gastrectomy. Final operative scheme after PD in patients with radical subtotal (A) and total (B) gastrectomy. Instead of dividing E-loop, it is pulled-up for pancreaticojejunostomy (PJ) and choledochojejunostomy (CJ). TA stapler is applied to prevent food materials from PJ/CJ site and additional BA is provided. TA, transverse anastomosis; BA, Braun anastomosis.

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  Fig. 2 Preoperative image. (A) Preoperative magnetic resonance image. Green arrow indicates periampullary tumor. (B) Preoperative endoscopic evaluation. Note protruding periampullary lesion at left upper area of the figure.

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