TY - JOUR
T1 - Pancreatic Head Resection Following Roux-en-Y Gastric Bypass
T2 - Operative Considerations and Outcomes
AU - the Pancreatic Head Resection after Roux-en-Y Gastric Bypass Study Group
AU - Trudeau, M. T.
AU - Maggino, L.
AU - Ecker, B. L.
AU - Vollmer, C. M.
AU - Allendorf, John D.
AU - Ball, Chad G.
AU - Baechle, Jordan
AU - Behrman, Stephen W.
AU - Chan, Carlos
AU - Corvera, Carlos U.
AU - Cioffi, Jessica L.
AU - Datta, Jash
AU - Dillhoff, Mary E.
AU - Flick, Katelyn F.
AU - Gumbs, Andrew A.
AU - Grochola, Lukasz Filip
AU - Idrees, Kamran
AU - Jajja, Mohammad Raheel
AU - Kooby, David A.
AU - Kruse, Edward J.
AU - Lowy, Andrew M.
AU - Moskowitz, Barbara A.
AU - Maxwell, Daniel L.
AU - Morris-Stiff, Gareth J.
AU - Morgan, Katherine A.
AU - O’Connor, Victoria V.
AU - Peng, June
AU - Schrope, Beth A.
AU - Sanford, Dominic E.
AU - Sulzer, Jesse K.
AU - Sarmiento, Juan M.
AU - Soufi, Mazhar
AU - Smith, Paula M.
AU - Shen, Perry
AU - Simpson, Rachel E.
AU - Thompson, Lee W.
AU - Vilchez, Valeria
AU - Vrochides, Dionisios V.
AU - Wisneski, Andrew D.
AU - Wray, Curtis J.
AU - Winslow, Emily R.
AU - Williams, Gregory A.
AU - Zaydfudim, Victor M.
N1 - Publisher Copyright:
© 2019, The Society for Surgery of the Alimentary Tract.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Purpose: This study aimed to identify optimal management decisions for surgeons preforming pancreatic head resection on patients with altered anatomy due to a previous Roux-en-Y gastric bypass (RYGB). Methods: A multi-national (4), multi-center (28) collaborative of 55 pancreatic surgeons who have performed pancreatoduodenectomy or total pancreatectomy following RYGB for obesity (2005–2018) was created. Demographics, operative details, and perioperative outcomes from this cohort were analyzed and compared in a propensity-score matched analysis with a multi-center cohort of 5533 pancreatoduodenectomies without prior RYGB. Results: Ninety-six patients with a previous RYGB undergoing pancreatic head resection were assembled. Pathologic indications between the RYGB and normal anatomy cohorts did not differ. Propensity score matching of RYGB vs. patients with unaltered anatomy demonstrated no differences in major postoperative outcomes. In total 20 distinct reconstructions were employed (of 37 potential options); the three most frequent reconstructions accounted for 52.1%, and none demonstrated superior outcomes. There were no differences in outcomes observed between original biliopancreatic limb use (66.7%) and those where a secondary Roux limb was created for biliopancreatic reconstruction. Remnant stomachs were removed in 54.7% of cases, with no outcome differences between resected and retained stomachs. Venting gastrostomy tubes were used in 36.2% of retained stomachs without obvious outcome benefits. Jejunostomy tubes were used infrequently (11.7%). Conclusions: Pancreatic head resection after RYGB is an infrequently encountered, unique and challenging scenario for any given surgeon. These patients do not appear to suffer higher morbidity than those with unaltered anatomy. Various technical reconstructive options do not appear to confer distinct benefits.
AB - Purpose: This study aimed to identify optimal management decisions for surgeons preforming pancreatic head resection on patients with altered anatomy due to a previous Roux-en-Y gastric bypass (RYGB). Methods: A multi-national (4), multi-center (28) collaborative of 55 pancreatic surgeons who have performed pancreatoduodenectomy or total pancreatectomy following RYGB for obesity (2005–2018) was created. Demographics, operative details, and perioperative outcomes from this cohort were analyzed and compared in a propensity-score matched analysis with a multi-center cohort of 5533 pancreatoduodenectomies without prior RYGB. Results: Ninety-six patients with a previous RYGB undergoing pancreatic head resection were assembled. Pathologic indications between the RYGB and normal anatomy cohorts did not differ. Propensity score matching of RYGB vs. patients with unaltered anatomy demonstrated no differences in major postoperative outcomes. In total 20 distinct reconstructions were employed (of 37 potential options); the three most frequent reconstructions accounted for 52.1%, and none demonstrated superior outcomes. There were no differences in outcomes observed between original biliopancreatic limb use (66.7%) and those where a secondary Roux limb was created for biliopancreatic reconstruction. Remnant stomachs were removed in 54.7% of cases, with no outcome differences between resected and retained stomachs. Venting gastrostomy tubes were used in 36.2% of retained stomachs without obvious outcome benefits. Jejunostomy tubes were used infrequently (11.7%). Conclusions: Pancreatic head resection after RYGB is an infrequently encountered, unique and challenging scenario for any given surgeon. These patients do not appear to suffer higher morbidity than those with unaltered anatomy. Various technical reconstructive options do not appear to confer distinct benefits.
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U2 - 10.1007/s11605-019-04366-y
DO - 10.1007/s11605-019-04366-y
M3 - Article
C2 - 31485901
AN - SCOPUS:85071753384
SN - 1091-255X
VL - 24
SP - 76
EP - 87
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -