Orsi Carolina, Davis Tyler, Moudy Paige, Ismael Hishaam
Department of Graduate Medical Education, General Surgery, The University of Texas at Tyler Health Science Center, 11937 US HWY 271, Tyler, TX 75708, United States.
Department of Surgery, The University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX 75708, United States.
J Surg Case Rep. 2024 Dec 2;2024(12):rjae762. doi: 10.1093/jscr/rjae762. eCollection 2024 Dec.
Performing a pancreaticoduodenectomy (PD) in patients having undergone a Roux-en-Y gastric bypass (RNYGB) poses a significant surgical challenge. We present a patient with a history of RNYGB and endoscopic ultrasound-directed transgastric ERCP (EDGE) procedure who underwent a successful PD. This 77-year-old female with history of open RNYBG presented with resectable pancreatic adenocarcinoma. A preoperative EDGE procedure was required for biliary decompression. A PD was performed by removing the entire biliopancreatic limb for oncologic resection. The reconstructive technique here involved utilizing the old common channel for the hepaticojejunostomy, pancreaticojejunostomy, and remnant gastrojejunostomy. The case also included Axios stent placement during a preoperative EDGE procedure. This case describes the first reported successful PD in a patient with prior RNYGB and EDGE procedure. Although the optimal technique for this clinical scenario remains unestablished, this unique case contributes to the literature by demonstrating an effective approach for practicing surgeons.
在接受过Roux-en-Y胃旁路术（RNYGB）的患者中进行胰十二指肠切除术（PD）是一项重大的外科挑战。我们报告了一例有RNYGB病史且接受过内镜超声引导下经胃内镜逆行胰胆管造影术（EDGE）的患者，该患者成功接受了PD手术。这位77岁的女性有开放性RNYBG病史，因可切除的胰腺腺癌就诊。术前需要进行EDGE手术以实现胆道减压。通过切除整个胆胰肢体进行肿瘤切除，实施了PD手术。这里的重建技术包括利用旧的共同通道进行肝空肠吻合术、胰空肠吻合术和残余胃空肠吻合术。该病例还包括在术前EDGE手术期间放置Axios支架。本病例描述了首例有RNYGB和EDGE手术史的患者成功接受PD手术的报道。尽管针对这种临床情况的最佳技术尚未确立，但这一独特病例通过向执业外科医生展示一种有效的方法，为文献做出了贡献。
