Mak Malcolm Han Wen, Shelat Vishalkumar G
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Transl Gastroenterol Hepatol. 2022 Jan 25;7:11. doi: 10.21037/tgh.2020.02.11. eCollection 2022.
The obesity epidemic continues to increase around the world with its attendant complications of metabolic syndrome and increased risk of malignancies, including pancreatic malignancy. The Roux-en-Y gastric bypass (RYGB) is an effective bariatric procedure for obesity and its comorbidities. We describe a report wherein a patient with previous RYGB was treated with a novel reconstruction technique following a pancreaticoduodenectomy (PD). A 59-year-old male patient with previous history of RYGB was admitted with painless progressive jaundice. Imaging revealed a distal common bile duct stricture and he underwent PD. There are multiple options for reconstruction after PD in patients with previous RYGB. The two major decisions for pancreatic surgeon are: (I) resection/preservation of remnant stomach and (II) resection/preservation of original biliopancreatic limb. This has to be tailored to the patient based on the intraoperative findings and anatomical suitability. In our patient, the gastric remnant was preserved, and distal part of original biliopancreatic limb was anastomosed to the stomach as a venting anterior gastrojejunostomy. A distal loop of small bowel was used to reconstruct the pancreaticojejunostomy and hepaticojejunostomy and further distally a new jejunojejunostomy performed. The post-operative course was uneventful, and the patient was discharged on 7 day. With the increase in number of bariatric procedures performed worldwide, pancreatic surgeons should be aware of the varied surgical reconstruction options for PD following RYGB. This should be tailored to the patient and there is no "one-size-fits-all".
肥胖症流行在全球范围内持续加剧，随之而来的是代谢综合征并发症以及包括胰腺癌在内的恶性肿瘤风险增加。Roux-en-Y胃旁路术（RYGB）是治疗肥胖症及其合并症的一种有效减肥手术。我们报告一例既往接受过RYGB手术的患者，在胰十二指肠切除术（PD）后采用了一种新颖的重建技术进行治疗。一名有RYGB手术史的59岁男性患者因无痛性进行性黄疸入院。影像学检查显示胆总管远端狭窄，遂接受了PD手术。对于既往接受过RYGB手术的患者，PD术后有多种重建选择。胰腺外科医生面临的两个主要决策是：（I）保留/切除残胃；（II）保留/切除原胆胰支。这必须根据术中发现和解剖学适宜性为患者量身定制。在我们的患者中，保留了胃残端，并将原胆胰支的远端部分作为胃空肠吻合术的排气口吻合至胃。使用一段远端小肠重建胰空肠吻合术和肝空肠吻合术，并在更远端进行了新的空肠空肠吻合术。术后过程顺利，患者于术后7天出院。随着全球范围内减肥手术数量的增加，胰腺外科医生应了解RYGB术后PD的各种手术重建选择。这应根据患者情况量身定制，不存在“一刀切”的方法。
