Pancreaticoduodenectomy after a Roux-en-Y gastric bypass.

BACKGROUND: The surgical management of periampullary lesions, status post-Roux-en-Y gastric bypass procedure (RYGBP), poses a challenge. The strategy should focus on managing the gastric remnant. METHODS: We propose a technique of managing the gastric remnant while doing a pancreaticoduodenectomy (PD) in a patient with a previous RYGBP. From September 2005 to June 2008, two patients with a previous RYGBP underwent PD with a modified technique. The records were reviewed with respect to preoperative, intraoperative, and postoperative data. RESULTS: Both patients were operated for a carcinoma of the head of pancreas. Neither patient underwent a preoperative endoscopic ultrasound. The operating times were 315 and 218 min. There was no mortality or morbidity seen. Neither patient was re-operated. The mean length of stay was 6 days. CONCLUSIONS: The technique suggests an approach of managing the gastric remnant and preventing delayed gastric emptying which resulted in a decreased length of hospital stay.